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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. 1.15Anatomical nasal index.
Width of piriform aperture (a) × 100
Length of piriform aperture (b)
Normal values:
Leptorrhine (Caucasian): < 46.9
Platyrrhine (black): 47.0–50.9
Chamaerrhine (e.g., Asian): 51.0–57.9
(After Knuszmann 1988.)
Fig. 1.16Clinical nasal index.
Width of piriform aperture (a) × 100
Height of pyramid (b)
Normal values:
Leptorrhine (Caucasian): 55.0–69.9
Platyrrhine (black): 70.0–84.9
Chamaerrhine (e.g., Asian): 85.0–99.9
Hyperchamaerrhine (black): > 100.0
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Fig. 1.17Lobular (tip) index.
Width of tip at ventral border of nares (a) × 100
Maximum width of lobule (b)
This index is normally about 70. It is smaller in the platyrrhine, black, and growth-
disturbed nose. It is greater in patients with excessive prominence of the nasal pyramid.
Fig. 1.18Projection index.
Projection of dorsum (a) × 100
Projection of lobule (b)
(a) Projection from the nasal base line of the bony dorsum at the nasion.
(b) Projection from the nasal base line of the lobule at the level of the tip.
The projection index is usually 55–65. Its clinical value is limited.
1.1.2External Nose (External Pyramid)
The external nose consists of four major parts (▶ Fig. 1.19):
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Fig. 1.19The four major parts of the external nose: bony pyramid, cartilaginous
pyramid, lobule, and soft-tissue areas.
1. Bony pyramid
2. Cartilaginous pyramid
3. Lobule
4. Soft-tissue areas
The bony pyramid, cartilaginous pyramid, and lobule
comprise about one-third of the external nose. Together
they form an integrated anatomical–physiological entity.
This is the result of the rigid fixation of the cartilaginous
vault to the lower margin of the bony pyramid (underlap of
1.0 to 1.5 mm; ▶ Fig. 1.20, and also ▶ Fig. 1.34 and ▶ Fig. 1.93)
and the junctions between the lobule and the cartilaginous
pyramid, in particular the connection (and overlap)
between the lateral crus of the lobular cartilage and the
lower margin of the triangular cartilage (▶ Fig. 1.20). At four
different areas, the pyramid consists of soft tissue, allowing
a certain amount of mobility (▶ Fig. 1.19 and ▶ Fig. 1.30).
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Fig. 1.20Bony pyramid, cartilaginous pyramid, lobule, and soft-tissue areas.
The external nasal pyramid is covered (from the outside to
the inside) by skin, subcutaneous connective fatty tissue,
and muscle fibers. The thickness and extent of these
various layers show considerable individual variation.
Bony Pyramid
The bony pyramid (or bony vault) is the bony part of the
external nose that projects above and anterior to both
NBLs. Its upper midpoint is the depth of the nasofrontal
angle or nasion. Its lowest point is the rhinion or K area.
The bony pyramid consists of the nasal bones, the nasal
part of the frontal bone including the nasal spine (spina
nasalis ossis frontalis), and the two frontal processes of the
maxilla (▶ Fig. 1.21).
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Fig. 1.21Bony pyramid.
1 = nasal bone; 2 = frontal bone (nasal part); 3 = frontal process of maxilla; 4 =
internasal suture; 5 = nasomaxillary suture; 6 = frontonasal suture; 7 = frontomaxillary
suture; 8 = anterior nasal spine; 9 = intermaxillary suture.
The nasal bones are small, oblong, and quadrangular. They
are thicker and narrower cranially and thinner and wider
caudally. They are attached to each other in the midline by
slightly serrated borders that form the internasal suture.
Cranially, they unite with the nasal part of the frontal bone
to form the frontonasal suture. About halfway down the
sloping side of the pyramid, their lateral margins meet the
frontal process of the maxilla at the frontomaxillary suture.
Their inside (dorsal) surface is smooth and forms part of
the anterior wall of the nasal cavity. It has an oblong
groove, the ethmoidal sulcus, for the anterior branch of the
ethmoidal nerve. The nasal bones often show small
perforations (nasal foramina) through which blood vessels
penetrate.
The frontal processes of the maxillae are situated
between the nasal and lacrimal bones and make up the
dorsal part of the bony vault. They are thicker than the
adjacent caudal parts of the maxillae. Lateral
osteotomies are usually carried out in this part of the
bony vault.
The piriform aperture is the anterior nasal aperture as
seen in a skull (▶ Fig. 1.21). It is bounded by the nasal
bones and the maxillae.
Cartilaginous Pyramid
The cartilaginous pyramid or vault is made up by the
septolateral cartilage and the two lateral membranous
areas with one to three accessory cartilages (▶ Fig. 1.20).
The septolateral cartilage (▶ Fig. 1.22) consists of:
Fig. 1.22Septolateral cartilage with reflection of the medial part of the caudal margin
of the triangular cartilage.
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