Skip to main content
SpringerLink
Log in

Nose

  • Chapter
  • First Online:
Cutaneous Flaps in Head and Neck Reconstruction

  • 3672 Accesses

Abstract

The nose is situated at the center of the face constituting the most prominent of the facial features. Its complicated contour makes it a unique functional organ and a predominant aesthetic unit with great impact in appearance. The soft tissues of the nose are arranged in discrete components that lie over its osseocartilaginous nasal skeleton. Outermost is the nose skin with special and variable characteristics. Just below the skin are layered the subcutaneous tissue, the nasal superficial musculoaponeurotic system (nasal SMAS), the deep areolar (deep fatty) layer, and the periosteum-perichondrium layer. The nose as donor site can provide flaps that reconstruct defects only of the nose itself. As a general rule, flaps that are derived from the nose can close nasal skin defects up to 2.5 cm. The nasal superficial arterial network that is provided by branches of the internal and the external carotid arteries is multidirectional in its flow. The result of this is the reason that nasal flaps pedicled even in unconventional positions can be very robust.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Aksoy F, Veyseller B, Yildirim YS, Acar H, Demirhan H, Ozturan O (2010) Role of nasal muscles in nasal valve collapse. Otolaryngol Head Neck Surg 142(3):365–369

    Article  PubMed  Google Scholar 

  • Blandini D, Tremolada C, Beretta M, Mascetti M (1996) Use of a versatile axial dorsonasal musculocutaneous flap in repair of the nasal lobule. Plast Reconstr Surg 98(2):260–268

    Article  CAS  PubMed  Google Scholar 

  • Bruintjes TD, van Olpen AF, Hillen B, Huizing EH (1988) A functional anatomic study of the nasal cartilages and muscles to the nasal valve area. Laryngoscope 108(7):1025–1032

    Article  Google Scholar 

  • Bruintjes TD, Olphen AF, Hillen B, Weijs WA (1996) Electromyography of the human nasal muscles. Eur Arch Otorhinolaryngol 253(8):464–469

    Article  CAS  PubMed  Google Scholar 

  • Burget GC (1985) Aesthetic restoration of the nose. Clin Plast Surg 12(3):463–480

    CAS  PubMed  Google Scholar 

  • Burget GC, Menick FJ (1985) The subunit principle in nasal reconstruction. Plast Reconstr Surg 76(2):239–247

    Article  CAS  PubMed  Google Scholar 

  • Chiu LD, Hybarger CP, Todes-Taylor N (1994) The Rintala flap revisited. Plast Reconstr Surg 94(6):801–807

    Article  CAS  PubMed  Google Scholar 

  • Chun KW, Kang HJ, Han SK, Lee ES, Chang H, Kim SB, Kim WK (2008) Anatomy of the alar lobule in the Asian nose. J Plast Reconstr Aesthet Surg 61(4):400–407

    Article  CAS  PubMed  Google Scholar 

  • Clark M, Greenfield B, Hunt N, Hall-Craggs M, McGrouther D (1998) Function of the nasal muscles in normal subjects assessed by dynamic MRI and EMG: its relevance to rhinoplasty surgery. Plast Reconstr Surg 101(7):1945–1955

    Article  CAS  PubMed  Google Scholar 

  • Drumheller GW (1973) Topology of the lateral nasal cartilages: the anatomical relationship of the lateral nasal to the greater alar cartilage, lateral crus. Anat Rec 176(3):321–327

    Article  CAS  PubMed  Google Scholar 

  • Ebrahimi A, Motamedi MHK, Nejadsarvari N (2012a) Morphologic variations of sesamoid cartilages of the nose in Iranian cadavers. Oral Surg Oral Med Oral Pathol Oral Radiol 114(2):22–25

    Article  Google Scholar 

  • Ebrahimi A, Nejadsarvari N, Koushki ES (2012b) Application of modified Rintala flap in nasal tip reconstruction. Am J Otolaryngol 33(6):685–688

    Article  PubMed  Google Scholar 

  • Esser JFS (1918) Gestielite lokale Nasenplastik mit zweizipfligem Lappen, Deckung des sekundaren Defektes vom ersten Zipfel durch den zweiten. Deutsche Zeitschr Chir 143:385–390

    Article  Google Scholar 

  • Erdogmus S, Govsa F (2006) Arterial features of inner canthus region: confirming the safety for the flap design. J Craniofac Surg 17(5): 864–868

    Google Scholar 

  • Galindo De Lara S, De Cuspinera GE, Cardenas Ramirez L (1977) Anatomical and functional account on the lateral nasal cartilages. Acta Anat 97(4):393–399

    Article  Google Scholar 

  • Gonzales-Ulloa M, Castillo A, Stevens E, Alverez Fuertes G, Leonelli F, Ubaldo F (1954) Preliminary study of the total restoration of the facial skin. Plast Reconstr Surg 13(3):151–161

    Article  Google Scholar 

  • Hur MS, Hu KS, Park JT, Youn KH, Kim HJ (2010) New anatomical insight of the levator labii superioris alaeque nasi and the transverse part of the nasalis. Surg Radiol Anat 32(8):753–756

    Article  CAS  PubMed  Google Scholar 

  • Hur MS, Hu KS, Youn KH, Song WC, Abe S, Kim HJ (2011) New anatomical profile of the nasal musculature: dilator naris vestibularis, dilator naris anterior, and alar part of the nasalis. Clin Anat 24(2):162–167

    Article  PubMed  Google Scholar 

  • Jackson JT (1985) Local flaps in head and neck reconstruction, 1st edn. Mosby, St Louis

    Google Scholar 

  • Jackson JT (2007) Local flaps in head and neck reconstruction, 2nd edn. Quality Medical Pub, St Louis

    Google Scholar 

  • Janeke JB, Wright WK (1971) Studies on the support of the nasal tip. Arch Otolaryngol 93(5):458–464

    Article  CAS  PubMed  Google Scholar 

  • Jewett SB, Baker RS (2011) Anatomic considerations. In: Baker RS (ed) Principles of nasal reconstruction. Springer, New York/Heidelberg/London

    Google Scholar 

  • Lang J (1989) Clinical anatomy of the nose, nasal cavity and paranasal sinuses. Thieme Medical Publishers Inc, New York

    Google Scholar 

  • Lessard ML, Daniel RK (1985) Surgical anatomy of septorhinoplasty. Arch Otolaryngol 111(1):25–29

    Article  CAS  PubMed  Google Scholar 

  • Letourneau A, Daniel RK (1988) The superficial musculoaponeurotic system of the nose. Plast Reconstr Surg 82(1):48–57

    Article  CAS  PubMed  Google Scholar 

  • Marchac D (1970) Lambeau de rotation fronto-nasal. Ann Chir Plast Esthet 15(1):44–49

    CAS  Google Scholar 

  • Marchac D, Toth B (1985) The axial frontonasal flap revisited. Plast Reconstr Surg 76(5):686–694

    Article  CAS  PubMed  Google Scholar 

  • Masson JK, Mendelson BC (1977) The banner flap. Am J Surg 134(3):419–423

    Article  CAS  PubMed  Google Scholar 

  • McGregor IA, McGregor FM (1986) Cancer of the face and mouth: pathology and management for surgeons. Churchill Livingstone, Edinburgh/London/Melbourne/New York

    Google Scholar 

  • Millard DR Jr (1981) Aesthetic reconstructive rhinoplasty. Clin Plast Surg 8(2):169–175

    PubMed  Google Scholar 

  • Nakajima H, Imanishi N, Aiso S (2002) Facial artery in the upper lip and nose: anatomy and a clinical application. Plast Reconstr Surg 109(3):855–861

    Google Scholar 

  • O’Hara D, Greenberg S, LaRossa D (1997) Superficial nasalis aponeurotic system (SNAS) flap reconstruction of nasal defects. Ann Plast Surg 38(4):379–384

    Article  PubMed  Google Scholar 

  • Ofodile FA, Bokhari FJ (1992) Columella incision in open rhinoplasty in Blacks (Letter). Plast Reconstr Surg 89(5):991–992

    CAS  PubMed  Google Scholar 

  • Ofodile FA, James EA (1997) Anatomy of alar cartilages in blacks. Plast Reconstr Surg 100(3):699–703

    Article  CAS  PubMed  Google Scholar 

  • Ofodile FA, Bokhari FJ, Ellis C (1993) The black American nose. Ann Plast Surg 31(3):209–218

    Article  CAS  PubMed  Google Scholar 

  • Oneal RM, Beil RJ Jr, Schlesinger J (1996) Surgical anatomy of the nose. Clin Plast Surg 23(2):195–222

    CAS  PubMed  Google Scholar 

  • Oneal RM, Beil RJ Jr, Izenberg PH, Schlesinger J (2000) Surgical anatomy of the nose. Oper Tech Plast Reconstr Surg 7(4):158–167

    Article  Google Scholar 

  • Potter JK, Rogers T, Finn R (2000) Macroscopic and microscopic details of the cartilaginous nasal pyramid. J Oral Maxillofac Surg 58(8):867–876

    Article  CAS  PubMed  Google Scholar 

  • Rieger RA (1967) A local flap for repair of the nasal tip. Br J Plast Surg 40(2):147–149

    CAS  Google Scholar 

  • Riml S, Wallner H, Larcher L, Kompatscher P (2011) The Superficial Nasalis Aponeurotic System (SNAS) flap for nasal tip reconstruction. Plast Reconstr Surg 128(1):19–22

    Article  Google Scholar 

  • Rintala AE, Asko-Seljavaara S (1969) Reconstruction of midline skin defects of the nose. Scand J Plast Reconstr Surg 3(2):105–108

    Article  CAS  PubMed  Google Scholar 

  • Rohrich RJ, Gunter JP, Friedman RM (1995) Nasal tip blood supply: an anatomic study validating the safety of the transcolumellar incision in rhinoplasty. Plast Reconstr Surg 95(5):795–799

    Article  CAS  PubMed  Google Scholar 

  • Rohrich RJ, Muzaffar AR, Gunter JP (2000) Nasal tip blood supply: confirming the safety of the transcolumellar incision in rhinoplasty. Plast Reconstr Surg 106(7):1640–1641

    Article  CAS  PubMed  Google Scholar 

  • Rohrich RJ, Griffin JR, Ansari M, Beran SJ, Potter JK (2004) Nasal reconstruction-beyond aesthetic subunits: a 15-year review of 1334 cases. Plast Reconstr Surg 114(6):1405–1416

    Article  PubMed  Google Scholar 

  • Saban Y, Amodeo AC, Hammou JC, Polselli R (2008) An anatomical study of the nasal superficial musculoaponeurotic system: surgical applications in rhinoplasty. Arch Facial Plast Surg 10(2):109–115

    Article  PubMed  Google Scholar 

  • Saban Y, Amodeo CA, Bouaziz D, Polselli R (2012) Nasal arterial vasculature: medical and surgical applications. Arch Facial Plast Surg 14(6):429–436

    Article  PubMed  Google Scholar 

  • Song R, Ma H, Pan F (2002) The “levator septi nasi muscle” and its clinical significance. Plast Reconstr Surg 109(5):1707–1712

    Article  PubMed  Google Scholar 

  • Standring S (2008) Gray’s anatomy. The anatomical basis of clinical practice, 40th edn. Churchill Livingstone-Elsevier, Edinburg

    Google Scholar 

  • Tardy ME (1990) Surgical anatomy of the nose. Raven, New York

    Google Scholar 

  • Thomaidis VK et al (2006) The dorsal nasal flap (article in Greek). Hell Arch Oral Maxillofac Surg 7(1):19–26

    Google Scholar 

  • Toriumi DM, Mueller RA, Grosch T, Bhattacharyya TK, Larrabee WF Jr (1996) Vascular anatomy of the nose and the external rhinoplasty approach. Arch Otolaryngol Head Neck Surg 122(1):24–34

    Article  CAS  PubMed  Google Scholar 

  • Watanabe K (1994) New ideas to improve the shape of the ala of the Oriental nose. Aesthetic Plast Surg 18(4):337–344

    Article  CAS  PubMed  Google Scholar 

  • Yotsuvanagi T, Yamashita K, Urushidate S, Yokoi K, Sawada Y (2000) Nasal reconstruction based on aesthetic subunits in Orientals. Plast Reconstr Surg 106(1):36–44

    Article  Google Scholar 

  • Zitelli JA (1989) The bilobed flap for nasal reconstruction. Arch Dermatol 125(7):957–959

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anatomy, Medical School Democritus University of Thrace, Alexandroupolis, Evros, Greece

    Vasilios K. Thomaidis MD, DDS, PhD

Authors
  1. Vasilios K. Thomaidis MD, DDS, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Thomaidis, V.K. (2014). Nose. In: Cutaneous Flaps in Head and Neck Reconstruction. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-41254-7_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-41254-7_4

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-41253-0

  • Online ISBN: 978-3-642-41254-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation