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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4450_Библиотеки_им_академика_М_И_Перельмана
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Fig. 2.51Bony and cartilaginous saddle nose. Both the bony and cartilaginous dorsum
are abnormally concave and low.
Both the bony and cartilaginous dorsum are concave. The
pyramid is broad and low. A bony and cartilaginous saddle
nose is one of the most common nasal deformities. It may
produce both functional and aesthetic complaints. The most
common causes are destruction of the anterior septum by
infection and/or severe trauma in childhood, and severe
frontal trauma with impression of the external pyramid.
Bony Saddle (▶ Fig. 2.52)
Fig. 2.52Bony saddle. The bony dorsum is abnormally concave and low.
The bony pyramid is concave, while the cartilaginous
dorsum is normal. This is a relatively rare type of
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pathology. It may result from a traumatic frontal impression
of the bony pyramid, or arise after over-resection of a bony
hump.
Cartilaginous Saddle (▶ Fig. 2.53)
Fig. 2.53Cartilaginous saddle. The cartilaginous dorsum is abnormally concave and low.
The cartilaginous dorsum is concave, while the bony
pyramid is normal. This is the most common type of
saddling. It is invariably related to septal pathology. A
defective anterior septum due to trauma, infection, or
inadequate surgery is the most common underlying cause.
Cartilaginous Sagging (▶ Fig. 2.54)
Fig. 2.54Cartilaginous sagging. The cartilaginous dorsum is slightly depressed due to
loss of support.
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Sagging of the cartilaginous dorsum is a minor variant of
saddling and has the same origin.
Dorsal Step (▶ Fig. 2.55 and ▶ Fig. 2.56)
Fig. 2.55Dorsal step. The continuity between the bony and cartilaginous pyramid is
disrupted, leading to a local depression.
Fig. 2.56Dorsal step. The continuity between the bony and cartilaginous pyramid is
disrupted, leading to a local impression.
The bony and the cartilaginous pyramid are detached at the
K area. The continuity between the bony and the
cartilaginous part of the nose is disrupted. A “step” is
present at the junction between the nasal bones and the
triangular cartilages, usually caused by frontal trauma with
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impression of the cartilaginous pyramid and septum. A
dorsal step may cause considerable cosmetic complaints.
Sagging of the Supratip Area (▶ Fig. 2.57)
Fig. 2.57Sagging of the supratip area.
The area just cranial to the tip is depressed. This may be
the result of localized trauma or may occur after septal and
lobular surgery.
Linea Nasalis Dorsalis (▶ Fig. 2.58)
Fig. 2.58Linea nasalis dorsalis. A horizontal crease in the skin just cranial to the lobule.
The linea nasalis dorsalis is a horizontal crease in the skin
of the cartilaginous dorsum just cranial to the lobule. It is
seen in patients with chronic secretory rhinitis as a result
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of permanent sniffing and wiping of the nose. It may also
occur as a minor variant of sagging of the cartilaginous
dorsum.
2.2.4Bony and Cartilaginous Pyramid
Other important conditions affecting the bony and/or
cartilaginous pyramid that occur as isolated symptoms or in
combination with other pathology are: asymmetry of the
pyramid, irregularity of the bony pyramid, a lateral “step,”
a defect of the bony pyramid, an open roof, asymmetry of
the cartilaginous pyramid, disruption of the triangular–
bony junction, and atrophy of the cartilaginous pyramid.
Asymmetry of the Bony Pyramid (▶ Fig. 2.59)
Fig. 2.59Asymmetry of the bony pyramid. The bony pyramid has unequal lateral walls
in terms of size and/or position.
The two sides of the bony pyramid are unequal in terms of
position and length. This is often seen in patients with a
deviated pyramid with impression of one of the bony walls.
This asymmetry is caused by trauma or inadequate
repositioning of the bony pyramid after osteotomies.
Irregularity of the Bony Pyramid (▶ Fig. 2.60)
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