Rhinoplasty: the nasal bones - anatomy and analysis

Overview

Surgeons plan bone work in rhinoplasty using landmarks that the authors judged too vague to describe real variation. They dissected cadavers using a two-part method, resecting the specimen and then making a replica of the skull, in order to take repeatable measurements and define new descriptive terms that match both anthropometric and clinical usage.

Sections of note

• 44 cadavers were studied with a two-part harvest and replica technique.
• The nasal bones were found to be irregular and variable in shape rather than uniform.
• Three distinct angles were identified along the profile line: the nasion angle, the dorsal profile angulation and the kyphion angulation.
• In 12 percent of cases the lower part of the nasal bones was straight, giving a V-shaped configuration.
• In 88 percent the lower part was angled, giving an S-shaped configuration.
• The bone from nasion to sellion was defined as the radix and the bone from sellion downward as the bony dorsum.

What it means for a patient

• The bony framework of the nose differs substantially from person to person, which is part of why a single standard operation does not fit every nose.
• Most noses have a bend in the lower nasal bone, so a surgeon planning to straighten a profile is not working with a flat surface.
• This is anatomical groundwork from cadavers, not a study of patients, so it reports no outcomes, complications or satisfaction.
• Cadaver specimens may not represent the age or ethnic range of people seeking rhinoplasty. The abstract does not describe the sample.

Why this paper matters

Reliable terminology is what lets surgeons compare results and teach technique. Naming three separate angles along the bridge gives a vocabulary for describing where a hump actually sits and where a cut should go. Whether using these definitions changes surgical results is untested.

Terms

• Nasal bones: the paired bones forming the upper third of the nose.
• Cadaver study: research on donated bodies rather than living patients.
• Nasion: the depression at the bridge of the nose where it meets the forehead.
• Sellion: the deepest point of the nasal profile, at the root of the nose.
• Bony dorsum: the bony part of the nasal bridge.
• Anthropometric: relating to standardised measurement of the human body.