Printer Friendly

The nasal septum: an osteometric study of 16 cadaver specimens.

Abstract

Studies of the shape, dimensions, and other morphologic characteristics of the nasal septum are scant in the literature. We conducted a study of 16 male cadavers to measure six osseous components of the nasal septum and to calculate the proportional contribution that each made to the total septal bone surface area. We found a wide range of inter-specimen variations in both categories. It is our hope that a better understanding of nasoseptal anatomy will improve surgical technique.

Introduction

The facial profile of individual patients, as well as the nasal characteristics of different ethnic and racial groups, can be attributed to the cartilaginous and bony variations in the shape and dimensions of the nasal septum. (1) The number, size, and variations of the bony elements of the septum and the high frequency with which these osseous elements deviate from the midline should make the study of septal anatomy an important endeavor. In cases of septal deviation, successful rhinoplasty depends on a thorough understanding of the normal nasal anatomy. However, the nasal septum remains a much-neglected area of osteometry. (2,3)

With the goal of building some base data, we conducted a morphometric analysis of the bony part of the septum. It is our hope that careful study of these anatomic features will make for a more prepared and confident surgeon and ultimately better surgical technique. (4,5)

Materials and methods

We collected anatomic data from dissection of 16 adult male cadavers in the Department of Anatomy at Kasturba Medical College in Mangalore, India. In each specimen, the mucoperiosteum covering the septum was stripped out, and the osseous components were demarcated. Then the surface area of each of the sixbony components--the perpendicular plate of the ethmoid bone, the vomer, the sphenoid bone, the nasal process of the frontal bone, the nasal bone, and the palatine crest--was measured with a transparent grid calibrated in square millimeters, Then we calculated the contributions that each of these bones made to the total osseous surface area and the contribution that the total bony component made to the total chondro-osseous septal surface area.

Results

The total surface area of the septae, including both the cartilaginous and bony parts, ranged from 2,374 to 4,107 [mm.sup.2] (mean: 2,822) (table). We found considerable interspecimen variations in the surface areas of the six individual bones, as well as considerable variations in the proportional contributions of these bones to the total bone surface area. The total bone surface area of the 16 septal specimens ranged from 1,439 to 3,562 [mm.sup.2] (mean: 1,974). Bony elements accounted for 54.79 to 86.73% of the total septal surface area (mean: 69.95%). Expressed another way, the chondral elements accounted for 13.27 to 45.21% of the total septal surface (data not shown).

The contributions of the ethmoid bone and the vomer to the total bone surface area were inversely proportional; specimens with the largest ethmoid bones had the smallest vomers, and vice versa. Overall, the ethmoid bones accounted for generally one-half to two-thirds of the total bone surface area (mean: 61.70%), and the vomers accounted for roughly less than one-third (mean: 25.70%) (table).

Discussion

Deviations in nasal septae usually involve the cartilage and the perpendicular plate of the ethmoid bone. (6) Sometimes the nasal crest of the palatine bone and the crest of the maxilla are involved, but the vomer is usually not. (6) The goal of septal reconstruction is to correct the architecture of the septum rather than to camouflage a curved or displaced nasal dorsum, as is done in some cosmetic procedures. (7)

When septal deviation or dislocation contributes to nasal obstruction or external deformity, surgical management should include septal restructuring and stabilization, as well as maintenance of the restored nasal septum with adequate support. (8) Nasal obstruction frequently involves the perpendicular plate of the ethmoid bone and the vomer, and it is traditionally treated with an open surgical procedure in which the mucoperiosteum is elevated and the offending bone is fractured and/or removed. (8) A deviated septum can also be treated with a closed septal osteotomy, which is a quick, simple, and easy way of straightening the bony part of the septum. (9)

Septorhinoplasty is the most difficult and complicated of facial plastic surgery procedures because of the complex interrelationships of the various anatomic structures. The techniques surgeons use to correct septal abnormalities are continually evolving. As part of this evolution, techniques are being refined on the basis of our increased understanding of the pertinent anatomy and three-dimensional relationships. (10,11) While surgeons have wide latitude in how we perform individual operations depending on the anatomy of a given patient, rhinoplasties generally involve five procedures:

* removing a dorsal hump;

* narrowing the bony nasal arch;

* lowering and/or shortening the upper lateral cartilages;

* narrowing and/or lowering the nasal tip; and

* shortening and fitting the cartilaginous septum.

A proper appreciation of the contribution that the different septal elements make to the entire nasal form will allow surgeons to more consistently achieve the functional and cosmetic goals of corrective rhinoplasty. (12) Surgeons will have a greater opportunity to enhance the cosmetic appearance of the visible portion of the nose if we have a good understanding of the nonvisible portions. Studies of this kind are important to basic and applied medical science.

References

(1.) Rogers BO. The role of physical anthropology in plastic surgery today. Clin Plast Surg 1974;1(3):439-98.

(2.) Freer OT. Deflections of the nasal septum and their correction by the window resection. Ann Otol Rhinol Laryngol 1905;14:213-66.

(3.) Godley FA. Nasal septal anatomy and its importance in septal reconstruction. Ear Nose Throat J 1997;76(8):498-501, 504-6.

(4.) Park S, Holt R. Rhinoplasty and septoplasty, part 1. In: Park S, Holt R, eds. Otolaryngologic Clinics of North America. Vol. 32, no.1. Philadelphia: W.B. Saunders; 1999.

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

(6.) Hollinshead WH. Anatomy for Surgeons. Vol. 1: The Head and Neck. 2nd ed. New York: Harper and Row; 1968:264.

(7.) Constantian MB. An algorithm for correcting the asymmetrical nose. Plast Reconstr Surg 1989;83(5):801-11.

(8.) Newman MH. Surgery of the nasal septum. Clin Plast Surg 1996; 23(2):271-9.

(9.) Gruber R, Lesavoy M. Simple technique to correct the bony septum. Plast Reconstr Surg 1998; 102(1):244-5.

(10.) Keefe MA, Cupp CL. The septum in rhinoplasty. Otolaryngol Clin North Am 1999;32(1):15-36.

(11.) Holt GR. Septorhinoplasty. Form versus function. Otolaryngol Clin North Am 1999;32(1):1-6.

(12.) Broadbent TR,Woolf RM. Anatomy of a rhinoplasty--sawtechnique. Ann Plast Surg 1984;13(1):67-75.

Latha Venkatraya Prabhu, MBBS, MS; Anu Vinod Ranade, MSc, PhD; Rajalakshmi Rai, MSc; Mangala M. Pai, MBBS, MD; Arunachalam Kumar, MBBS, MS; Prakash Sinha, MBBS, MD; Soubhagya Ranian Nayak, MSc

From the Department of Anatomy, Kasturba Medical College, Mangalore, India (Dr. Prabhu, Dr. Rai, Dr. Pai, Dr. Sinha, and Dr. Nayak); the Department of Anatomy, Gulf Medical University, Ajman, United Arab Emirates (Dr. Ranade); and the Department of Anatomy, K.S. Hegde Medical Academy, Mangalore (Dr. Kumar).

Corresponding author: Dr. Anu Vinod Ranade, Department of Anatomy, Gulf Medical University, PO Box 4184, Ajman, UAE. Phone: 9716-743-1333; fax: 9716-743-1222; e-mail: anuranade@gmail.com
Table. Surface area of each septal bone and its percentage
of the total bone surface area

             Total
             septal
            surface               Ethmoid         Vomer

Specimen                        [mm.sup.2](%)

1             2,430              912 (59.57)    457 (29.85)
2             2,470              846 (58.79)    315 (21.89)
3             2,578            1,046 (71.99)    271 (18.65)
4             3,093            1,060 (50.38)    700 (33.27)
5             2,848            1,032 (55.28)    571 (30.58)
6             2,396            1,053 (51.37)    636 (31.02)
7             3,462            1,612 (64.02)    629 (24.98)
8             2,374              817 (49.97)    585 (35.78)
9             2,595            1,086 (57.64)    619 (32.86)
10            2,670            1,026 (70.13)    256 (17.50)
11            3,010              917 (49.76)    638 (34.62)
12            2,797            1,383 (74.43)    248 (13.35)
13            2,858            1,566 (65.94)    511 (21.52)
14            2,747            1,205 (62.34)    543 (28.09)
15            2,718            1,219 (58.92)    600 (29.00)
16            4,107            2,706 (75.97)    539 (15.13)
Mean          2,822          1,217.9 (61.70)    507 (25.70)

                  Sphenoid         Frontal         Nasal

Specimen                         [mm.sup.2](%)

1                25 (1.63)        26  (1.70)     53 (3.46)
2                18 (1.25)        22  (1.53)     38 (2.64)
3                23 (1.58)        23  (1.58)     30 (2.06)
4                52 (2.47)        33  (1.57)     70 (3.33)
5                28 (1.50)        16  (0.86)     32 (1.71)
6                52 (2.54)        34  (1.66)     28 (1.37)
7                20 (0.79)        80  (3.18)     35 (1.39)
8                24 (1.47)        14  (0.86)     22 (1.35)
9                13 (0.69)        56  (2.97)     20 (1.06)
10               22 (1.50)        20  (1.37)     19 (1.30)
11               21 (1.14)        75  (4.07)     33 (1.79)
12               31 (1.67)         9  (0.48)      5 (0.27)
13               96 (4.04)        20  (0.84)     11 (0.46)
14               44 (2.28)        31  (1.60)     20 (1.03)
15               15 (0.72)        50  (2.42)     22 (1.06)
16               68 (1.91)        50  (1.40)     37 (1.04)
Mean           34.5 (1.75)      34.9  (1.77)   29.7 (1.50)

                                  Total
                                   bone
                 Palatine        surface *

Specimen              [mm.sup.2](%)

1                58 (3.79)     1,531 (63.00)
2               200 (13.90)    1,439 (58.26)
3                60 (4.13)     1,453 (56.36)
4               189 (8.98)     2,104 (68.02)
5               188 (10.07)    1,867 (65.55)
6               247 (12.05)    2,050 (72.73)
7               142 (5.64)     2,518 (68.87)
8               173 (10.58)    1,635 (72.60)
9                90 (4.78)     1,884 (54.79)
10              120 (8.20)     1,463 (61.23)
11              159 (8.63)     1,843 (66.43)
12              182 (9.80)     1,858 (83.10)
13              171 (7.20)     2,375 (70.37)
14               90 (4.66)     1,933 (76.12)
15              163 (7.88)     2,069 (86.12)
16              162 (4.55)     3,562 (86.73)
Mean          149.6 (7.58)     1,974 (69.95)

* The percentages in this column indicate the proportion
of the total septal surface area that is made up of bone.
COPYRIGHT 2009 Vendome Group LLC
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2009 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Title Annotation:ORIGINAL ARTICLE
Author:Prabhu, Latha Venkatraya; Ranade, Anu Vinod; Rai, Rajalakshmi; Pai, Mangala M.; Kumar, Arunachalam;
Publication:Ear, Nose and Throat Journal
Article Type:Report
Geographic Code:9INDI
Date:Aug 1, 2009
Words:1765
Previous Article:Complete round window niche occlusion for superior semicircular canal dehiscence syndrome: a minimally invasive approach.
Next Article:Three spontaneous occurrences of nasal septal abscess in patients with chronic asymptomatic HIV--the need for early intervention and reconstruction.
Topics:


Related Articles
Nasal septal perforation: A rare extraintestinal manifestation of Crohn's disease.
Endoscopic view of a hematoma of the nasal septum.
Structural and ultrastructural study of the anterior portion of the nasal septum and inferior nasal concha.
Technique and timing for closed reduction of isolated nasal fractures: A retrospective study. (Original Article).
Fibrin glue prevents complications of septal surgery: Findings in a series of 100 patients. (Original Article).
Endoscopic view of a nasal septal hemangioma causing obstruction.
The effect of silver nitrate on nasal septal cartilage.
The vomeronasal (Jacobson's) organ.
Chondrosarcoma of the nasal septum.
An asymptomatic schwannoma of the nasal septum: Report of a unique case.

Terms of use | Privacy policy | Copyright © 2019 Farlex, Inc. | Feedback | For webmasters