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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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The cartilaginous septum (cartilago septi nasi) that
rests on the premaxilla including its anterior nasal
spine, dividing the internal nose into two cavities, and
The two triangular cartilages that form the greater part
of the dorsal and lateral walls of the cartilaginous vault
The attachment of the cartilaginous vault to the bony
pyramid is rigid. The upper margin of both triangular
cartilages underlap the lower margin of the nasal bones by
1 to 2 mm over a distance of 5 to 10 mm (▶ Fig. 1.20). See
also ▶ Fig. 1.93 and ▶ Fig. 1.94; ▶ Junction between the Triangular
Cartilage and Nasal Bones. The area where the nasal bones,
the septal cartilage, and the two triangular cartilages unite
is commonly called the keystone or K area (see ▶ Fig. 1.7).
The cartilaginous vault is a T-shaped construction. Its angle
gradually diminishes from about 15° at the lower margin of
the triangular cartilage to almost 90° at the K area (▶ Fig.
1.23). See also ▶ Fig. 1.95 and ▶ Fig. 1.96; ▶ Septolateral
Cartilage: Cartilaginous Septum and Triangular Cartilages. In this
way, a funnel-type construction is created that plays an
important role in breathing and conditioning of the inspired
air (see ▶ Respiration).
Fig. 1.23Cross sections through the septolateral cartilage at the valve area, posterior
to the valve, and at the K area.
The septal cartilage (cartilaginous septum) rests with its
base on a bony pedestal consisting (from ventral to dorsal)
of the anterior nasal spine, the anterior part of the nasal
crest of the maxilla (often referred to as the premaxilla),
and the vomer. Caudally, it has a free, somewhat mobile
end that is connected to the columella by the membranous
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septum. Dorsally, it is united with the perpendicular plate
of the ethmoid bone. Ventrally, it is continuous with the two
triangular (or upper lateral) cartilages. Together they make
the cartilaginous vault and dorsum. See also ▶ Fig. 1.67, ▶
Fig. 1.68, ▶ Fig. 1.69, and ▶ Fig. 1.70; ▶ Chondrospinal Junction
and ▶ Chondropremaxillary Complex.
The triangular cartilages (upper lateral cartilages) are
continuous with each other and with the septal cartilage.
Together they constitute the cartilaginous vault. Cranially,
their margins are underlying, and firmly fixed to, the
caudal margin of the nasal bones. Medially, the triangular
cartilage is lined by mucosa. It covers the inside of the
cartilaginous part of the internal nasal cavity. Dorsally, it is
connected with the lateral soft-tissue or “hinge” area (see ▶
Fig. 1.20). Ventrally, it is continuous with the septum in its
upper two-thirds, while in its lower third, a small cleft with
loose connective tissue is found between its medial margin
and the septum (medial soft-tissue area or paraseptal cleft).
The length of this cleft is variable and related to the length
of the nose.
The caudal margin of the triangular cartilage is free and
protrudes into the vestibule. Its lateral side is covered by
skin (the “cul de sac”). The medial third of the caudal
margin is usually rotated upward 160 to 180°. This is called
returning, scrolling, or curling (see ▶ Fig. 1.22).
The caudal margin of the triangular cartilage moves inward
and outward with respiration (valve function). These
movements are possible because of its relatively loose
fixation to the medial and lateral soft-tissue areas (the cleft
and the hinge areas, respectively). The reflection of the
medial part of the lower margin, on the other hand,
increases its rigidity and thus counteracts an easy collapse
of the lateral nasal wall on inspiration.
The relationship between the triangular cartilage and the
lateral crus of the lobular cartilage shows large variations.
The most common relationship is a certain overlap of the
caudal margin of the triangular cartilage by the cranial
margin of the lateral crus of the lobular cartilage. Other
relationships that may be found are: “end-to-end,” “scroll,”
and “opposed scroll” ([53]) (▶ Fig. 1.24). In the dense
connective tissue that connects the lateral crus to the
triangular cartilage, several sesamoid cartilages can be
found. They provide both mobility and stability, allowing
the intercartilaginous area to act more or less as a joint
(see also ▶ Fig. 1.95, ▶ Fig. 1.96, and ▶ Fig. 1.97; ▶ Septolateral
Cartilage: Cartilaginous Septum and Triangular Cartilages).
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Fig. 1.24Most common relationships between the triangular cartilage (TC) and the
lobular cartilage (LC).
Nomenclature of Triangular Cartilage
Nomina Anatomica (NA): cartilago nasi lateralis (lateral nasal
cartilage)
North America: upper lateral cartilage (ULC)
Germany: Seitenknorpel
France: cartilage laterale
This book: triangular cartilage (TC)
Lobule
The lobule is the mobile lower third of the external nasal
pyramid. It is made up of two lobular cartilages, muscle
fibers, subcutaneous connective and fatty tissue, and a
relatively thick skin with sebaceous glands. The major
structures of the lobule are illustrated in ▶ Fig. 1.25 and ▶
Fig. 1.26.
Fig. 1.25Lateral view of the lobule with its major anatomical–clinical structures.
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Fig. 1.26Base view of the lobule with its main structures.
Tip
The tip (apex nasi) consists of the two domes, the
interdomal connective tissue fibers, and the overlying skin.
Supratip area: a slight depression just cranial to the tip
(“the dip before the tip”)
Tip-defining point: most prominent area of the dome of
the lobular cartilage; the tip is made up of the two tip-
defining points
Infratip area: part of the lobule anterior (ventral) to the
nostrils and the columella
Alae
The alae are the mobile lateral walls of the lobule that are
made up of the lateral crura of the lobular cartilage and the
overlying muscles and skin.
Alar rim: caudal margin of the ala; together with the
columella and the nostril sill, it forms the nostril
(ostium externum or naris)
Alar base (alar foot): area of attachment of the ala to
the face
Facet: flat area at the ventrocaudal part of the ala
corresponding to the caudal lobular notch (see ▶ Fig.
1.30)
Vertical alar groove: vertical groove or depression of
the ala just medial to the dome
Supra-alar groove or crease: horizontal groove just
above the cranial margin of the lateral crus
Alar-facial groove: fold at the alar base between the ala
and face
Columella
The columella is the midline structure running from the
upper part of the lobule to the upper lip, consisting of the
medial crura of the lobular cartilage. The columella is more
or less broadened due to the lateral (outward) curvature of
the end of the medial crura.
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Columellar break: slight bend of the lower margin of
the columella at the level of the upper (ventral) margin
of the nostril
Midcolumellar groove: vertical groove in the skin
between the medial crura
Nostril (Naris, Ostium Externum)
The orifices of the lobule are usually called the nostrils or
nares. They are bounded by the columella, lower alar rim,
and the nostril sill.
Nostril sill: inferior (dorsal) rim of the nostril
Vestibule
The vestibule is the skin-covered cavity between the nostril
and the valve area. Its upper part, lateral to the protruding
caudal margin of the triangular cartilage, is a blind-ending
pouch commonly called the cul de sac. The caudal part of
the vestibule bears hairs (vibrissae) that help protect the
entrance of the respiratory tract against insects, etc.
Nomenclature of Lobular Cartilage
Nomina Anatomica (NA): cartilago alaris major (greater alar
cartilage)
North American: lower lateral cartilage; alar cartilage
German: Flügelknorpel
This book: lobular cartilage
Lobular Cartilages
The lobular cartilages are horseshoe-shaped cartilages that
support the structured anatomy of the whole lobule. They
determine the position and form of the tip, the alae, and the
columella as well as the configuration of the nares and
vestibules.
The lobular cartilage can be divided into three or four parts
(▶ Fig. 1.27):
Fig. 1.27Left lobular cartilage with its anatomical parts.
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