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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. 2.68Broad tip.
The tip is broad and usually round (ballooning). The domes
are wide, convex, and sometimes far apart. The skin is
generally thick. This variation has no functional
consequences.
Square Tip (▶ Fig. 2.69)
Fig. 2.69Square tip.
The tip is broad and square. The domes are wide and more
or less double angulated. The skin is usually thick. Nasal
function is not impaired.
Bulbous (Amorphous) Tip (▶ Fig. 2.70)
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Fig. 2.70Bulbous (amorphous) tip.
The tip is massive and undefined because of a thick skin
and an abnormally large amount of subcutaneous
connective, fatty, and glandular tissue. The lobular
cartilages are usually large and thick. Nasal function is
usually not compromised.
Ball Tip (▶ Fig. 2.71)
Fig. 2.71Ball tip.
The tip is round both in its horizontal and vertical
dimension due to round and wide domes.
Bifid Tip, Double Tip, Distended Tip (▶ Fig. 2.72)
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Fig. 2.72Bifid tip, double tip, distended tip.
The tip is double, and the distance between the two domes
is abnormally large. Between the two domes is a vertical
groove or depression of the skin that may continue in a
vertical columellar groove. Bifidity of the nasal tip is a
congenital anomaly caused by incomplete fusion of the two
nasal processes in embryonic life. Complaints due to a bifid
tip are only aesthetic in nature.
Asymmetrical Tip (▶ Fig. 2.73)
Fig. 2.73Asymmetrical tip.
The tip is asymmetrical due to differences in the size and
position of the two domes. Asymmetry of the tip may be
congenital but may also result from inadequate tip or
lobular surgery. Cleft lip is another well-known cause.
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Overprojected Tip (▶ Fig. 2.74)
Fig. 2.74Overprojected tip.
The tip is abnormally prominent (projected) in relation to
the level of the cartilaginous and bony pyramid. An
overprojected tip may occur as an isolated congenital
abnormality. It may also be associated with a prominent
narrow lobule with a long columella and slitlike nostrils.
Underprojected Tip (▶ Fig. 2.75)
Fig. 2.75Underprojected tip.
The tip is abnormally low (depressed) in relation to the
cartilaginous and bony pyramid. An underprojected tip may
occur as an isolated congenital abnormality. It may also be
due to retraction of the columella and the membranous
septum as a result of a defective anterior septum.
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Upwardly Rotated Tip (▶ Fig. 2.76)
Fig. 2.76Upwardly rotated tip.
The nasolabial angle is abnormally large. This may occur as
a congenital anomaly in individuals with a very short nose.
It is also seen after rhinoplasty cases in which the nose was
shortened too much.
Hanging (Pendant, Drooping) Tip (▶ Fig. 2.77)
Fig. 2.77Hanging (pendant, drooping) tip.
The tip is low and hanging, and the nasolabial angle is
abnormally small. This is seen in the elderly, particularly in
males, and is caused by increasing laxity of the soft tissues.
It is also seen as a complication following rhinoplasty. It
may occur for various reasons; for example, after an
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