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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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external approach by retraction of the columella and
membranous septum, or due to loss of support of the
domes following the luxation technique.
Alae
Thin Alae (▶ Fig. 2.78)
Fig. 2.78Thin alae.
The alae are thin, usually long, and less convex than
average. They are more or less “stretched” and often
flaccid as a result of pronounced growth of the septum.
Thin and flaccid alae, especially when combined with
slitlike nostrils, easily collapse on inspiration. Thin alae are
generally part of a prominent, narrow lobule.
Thick Alae (▶ Fig. 2.79)
Fig. 2.79Thick alae.
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The alae are thick and usually short. This is mainly due to
the thickness of the skin and the subcutaneous tissue. The
condition may be part of a low, wide lobule, though it also
occurs in isolation.
Convex (Ballooning) Alae (▶ Fig. 2.80)
Fig. 2.80Convex (ballooning) alae.
The alae are strongly curved or ballooning, and the lateral
crus is abnormally convex.
Concave Alae (▶ Fig. 2.81)
Fig. 2.81Concave alae.
The alae are concave and may show a deep furrow. In
pronounced cases, inspiratory collapse may occur.
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Asymmetrical Alae (▶ Fig. 2.82)
Fig. 2.82Asymmetrical alae.
The alae are asymmetrical, either as part of a congenital
malformation, or as a result of trauma or surgery. A
unilateral cleft lip is the most common cause. In this entity,
the ala is shorter and abnormally convex while the alar
base is located in a more cranial position.
Pronounced Horizontal Alar Groove (▶ Fig. 2.83)
Fig. 2.83Pronounced horizontal alar groove.
The ala shows a horizontal groove. This may be due to a
congenital concavity of the lateral crus, or the result of
over-resection of cartilage from its cranial margin.
Pronounced Vertical Alar Groove (▶ Fig. 2.84)
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Fig. 2.84Pronounced vertical alar groove.
The ala shows a vertical groove at the transition between
the dome and the lateral crus. This is usually congenital but
may also result from cutting through the dome in lobular
surgery.
Columella
Long Columella (▶ Fig. 2.85)
Fig. 2.85Long columella.
The columella is long and generally narrow. This
abnormality is seen in the prominent-narrow pyramid
syndrome (see ▶ Prominent-Narrow Pyramid Syndrome (Tension
Nose)).
Short Columella (▶ Fig. 2.86)
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Fig. 2.86Short columella.
The columella is short and usually broad. This is seen in the
congenitally wide, low lobule, and as part of the low-wide
pyramid syndrome (see ▶ Resistance and Capacitance Vessels)).
Broad Columella (▶ Fig. 2.87)
Fig. 2.87Broad columella.
The columella is abnormally broad and usually short. This
variation is almost always congenital. The two medial crura
are far apart, separated by an abnormal amount of
connective tissue. A broad columella may show a vertical
columellar groove (see ▶ Fig. 2.94).
Protruding End of Medial Crura (▶ Fig. 2.88)
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