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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. 2.88Protruding end of the medial crura.
The end of one or both medial crura is abnormally curled
and protrudes into the vestibule. Inspiratory breathing may
be impaired, especially when this abnormality is combined
with a narrow nostril, a dislocated caudal end of the
septum, or a thin, flaccid ala.
Narrow Columella (▶ Fig. 2.89)
Fig. 2.89Narrow columella.
The columella is narrow and usually long. This variation is
seen in Caucasians in the prominent-narrow pyramid
syndrome.
Oblique Columella (▶ Fig. 2.90)
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Fig. 2.90Oblique columella.
The most common cause of an oblique columella is
dislocation of the caudal end of the septum. It is also seen
in congenital asymmetries of the lobule such as in cleft-lip
patients, or following surgery.
Retracted (Hidden) Columella (▶ Fig. 2.91)
Fig. 2.91Retracted (hidden) columella.
The columella, in particular its base, is retracted in a
cranial direction. Its lower margin is above the level of the
alar rim. When the nose is examined from the side, the
columellar base is “hidden” by the ala. The nasolabial angle
is smaller than normal. Retraction of the columella may be
caused by a defective caudal septal end, scarring of the
membranous septum, or by a fractured or resected anterior
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nasal spine. A midcolumellar retraction may be caused by
undesired scarring of a horizontal columellar incision, as in
the external approach.
Hanging (“Showing”) Columella (▶ Fig. 2.92)
Fig. 2.92Hanging (“showing”) columella.
The columella is abnormally low in relation to the alae. Its
lower part is usually curved to some extent, or “hanging.”
When the nose is inspected from the side, too much of the
columella is visible. This may cause cosmetic complaints.
Nasal function is not impaired. A hanging columella may be
of congenital origin or the result of lobular surgery.
Asymmetrical Columella (▶ Fig. 2.93)
Fig. 2.93Asymmetrical columella.
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The left and right halves of the columella are unequal in
level or width. This may be caused by asymmetry of the
medial crura or by dislocation of the caudal end of the
septum. An unequal lower margin of the columella is
usually a complication of surgery, for example
asymmetrical suturing of the infracartilaginous incision or
asymmetrical septocolumellar sutures.
Bifid Columella (▶ Fig. 2.94)
Fig. 2.94Bifid columella.
The columella shows a more or less pronounced vertical
groove between the medial crura. This is a sign of
incomplete fusion of the left and right nasal primordium
during development. The condition is similar to the bifid
tip. These developmental abnormalities are often seen
together.
Nostrils (Nares)
Narrow (Slitlike) Nostril (▶ Fig. 2.95)
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Fig. 2.95Narrow (slitlike) nostril.
The nostrils are narrow and elongated, resembling a slit to
a certain degree. This is seen in Caucasians as part of a
prominent, narrow lobule.
Wide Nostril (▶ Fig. 2.96)
Fig. 2.96Wide nostril.
The nares are wide and often circular or, to some extent,
square. This is seen among black people and Asians, and in
the pathologically low, wide lobule.
Asymmetrical Nostrils (▶ Fig. 2.97)
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