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Perez PI, Mei C, Lindsay RW, Gadkaree SK. Nasal Airway Evaluation. Facial Plast Surg 2024; 40:287-293. [PMID: 38198819 DOI: 10.1055/s-0043-1777839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
The nose has several important functions including inspiration, humidification of air, and filtering of allergens. The nose also has a major role in facial harmony as the central focal point. Patients will present to the rhinoplasty surgeon in an effort to fix the inability to breathe through the nose or correct a perceived nasal deformity in the shape of the nose. Choosing the optimal techniques to effectively change the nose requires a thorough understanding of nasal anatomy and nasal mechanics. Ultimately, a complete nasal evaluation is essential in identifying what corresponds to a patient's complaints and how those issues can be addressed surgically or perhaps nonsurgically. When the nose is divided into subunits, and a systematic nasal analysis is performed, one can be confident that all components of the nasal skeleton have been assessed.
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Affiliation(s)
- Paloma I Perez
- Department of Otolaryngology Head and Neck Surgery, Blanchfield Army Community Hospital, Fort Campbell, Kentucky
| | - Christine Mei
- Department of Otolaryngology Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Robin W Lindsay
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Shekhar K Gadkaree
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida
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2
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Caropreso CA, Porpino R, Neves JC, Ichiba G, Hirotani P, Carvalho V, Souza MC, Rodrigues JL. A Novel Treatment for Convex Lateral Crura: The Inverted Spanning Suture. Facial Plast Surg 2024. [PMID: 38631381 DOI: 10.1055/a-2308-3649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
Rhinoplasty is one of the most complex and challenging procedures in plastic surgery, even for experienced surgeons. Among the steps leading to an aesthetic and functional nose, there is the nasal tip improvement. Today's approach to nasal tip is the product of different techniques shifting through time, mainly from a resection tendency, to preservation and suture use to reshape cartilages. Addressing the lateral crura is vital to an aesthetic nasal tip and it is frequently obtained by adequate suture techniques. The alar-spanning suture described by Perkins is one of such. Regardless of its importance, it was not able to improve convex crura in some cases. The inverted alar-spanning suture (ISS) is an adaptation designed to treat those cases with the suture alone. ISS is a novel technique that can lead to better results treating the convex lateral crura by distributing the force vector in a more effective way. New techniques in rhinoplasty have multiplied, bringing this procedure to a new level and keeping up with the updated notion of restoration instead of excision the ISS is a new, precise, approach to an old problem.
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Affiliation(s)
| | - Rafael Porpino
- Department of Facial Plastic Surgery, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - José Carlos Neves
- Department of Facial Plastic Surgery, My Face Clinic, Lisboa, Portugal
| | - Gabriela Ichiba
- Department of Facial Plastic Surgery, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Paula Hirotani
- Department of Facial Plastic Surgery, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Victor Carvalho
- Department of Facial Plastic Surgery, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Maria Carolina Souza
- Department of Facial Plastic Surgery, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - José Luiz Rodrigues
- Department of Facial Plastic Surgery, Universidade de São Paulo (USP), São Paulo, SP, Brazil
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3
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Song L, Liu X. Evaluating the therapeutic and reconstructive efficacy of flap transplantation techniques in managing nasal tissue deficiency resulting from post-rhinoplasty surgical infections. Int Wound J 2024; 21:e14566. [PMID: 38379268 PMCID: PMC10809024 DOI: 10.1111/iwj.14566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 11/26/2023] [Accepted: 12/04/2023] [Indexed: 02/22/2024] Open
Abstract
Rhinoplasty is a frequently performed aesthetic surgery with a high procedural volume. Despite the operational ease and safety profile of biocompatible materials such as silicone and inflatable prosthetics, postoperative complications like surgical site infections can lead to significant clinical challenges. These complications necessitate effective therapeutic and reconstructive interventions. This study aims to evaluate the efficacy of different flap transplantation techniques for early treatment of post-rhinoplasty nasal tissue deficiencies. A retrospective study was conducted from May 2018 to May 2023, involving 38 patients divided into a control group receiving standard anti-infective treatment and an observation group undergoing early flap grafting procedures. Efficacy was evaluated using objective metrics-namely, nasal appearance, function and flap condition-each assessed through a 10-point scoring system, and subjective metrics such as patient satisfaction gauged through self-administered questionnaires. Statistical analyses were performed using SPSS version 27.0. Both groups were statistically comparable in terms of demographics such as age, marital status and educational background. The observation group displayed significantly improved outcomes in terms of nasal aesthetics (mean score 7.92 ± 1.00), nasal function (mean score 8.47 ± 0.51) and flap condition (mean score 7.89 ± 1.12) compared to the control group. Flap transplantation techniques demonstrated superior therapeutic and reconstructive efficacy in the management of nasal tissue deficiencies arising from post-rhinoplasty surgical infections. These findings contribute to evidence-based recommendations for optimal clinical practice.
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Affiliation(s)
- Lei Song
- Cosmetic ClinicBeijing Scarlette Medical ClinicBeijingChina
| | - Xiuyan Liu
- Cosmetic ClinicBeijing Scarlette Medical ClinicBeijingChina
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4
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Altidor A, Ferri FA, Bakhos F, Mascaro-Pankova A. Functional Rhinoplasty. Cureus 2023; 15:e45993. [PMID: 37900451 PMCID: PMC10601979 DOI: 10.7759/cureus.45993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
The nose is composed of intricate intranasal anatomy to serve its sophisticated functions. Although it only occupies a small area, it is the central focal point of the face and demands the highest level of understanding of the delicate interplay of form and function. Functional rhinoplasty, as opposed to aesthetic rhinoplasty, primarily aims to enhance nasal breathing and olfaction without altering the nose's appearance. The goal of this study is to describe the anatomy and physiology of the nose as well as the pathophysiology of nasal obstruction and the surgical approaches available for functional rhinoplasty. Whether when performed alone or combined with cosmetic rhinoplasty, functional rhinoplasty is a procedure that can bring significant benefits and improve the quality of life of our patients. Understanding nasal anatomy and physiology is key for successful management and outcomes. To provide optimal treatment for the patients, plastic surgeons must be familiarized with various techniques that have been documented.
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Affiliation(s)
| | - Francisco A Ferri
- Plastic and Reconstructive Surgery, Cleveland Clinic Florida, Weston, USA
| | - Fadi Bakhos
- Plastic and Reconstructive Surgery, Cleveland Clinic Florida, Weston, USA
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McIntosh C, Stutterheim J, Prinsloo H, Randall M, Toman J, Pisapia F. The RhinoCEROS Guidelines: A Practical Tool for Reporting Nasal Anatomy on Computed Tomography Pertaining to Rhinoplasty. Facial Plast Surg 2023. [PMID: 36596465 DOI: 10.1055/a-2006-0916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Cone-beam computed tomography (CT) is gaining popularity worldwide due to an increasingly diffuse and affordable in-office availability. It is becoming more commonplace for rhinoplasty surgeons to utilize this imaging as tool for preoperative assessment; however, there is inconsistency among radiologists commenting on specific structures of the nose or nasal cavity as there is currently no standardized reporting protocol. The goal of this article is to present clear guidelines for radiologists to report relevant nasal anatomy in the context of preoperative rhinoplasty evaluation. We have proposed the RhinoCEROS Guidelines, which stands for: Rhinoplasty Cephalometric Evaluation for Radiologic pre-Operative Systematization. This guideline highlights the primary aspects of nasal anatomy on CT that affect rhinoplasty outcomes and will provide radiologists with a straightforward template for reporting this increasingly popular use for CT scan.
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Affiliation(s)
| | | | | | - Michael Randall
- Department of Otolaryngology Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Morsani College of Medicine, University of South Florida, Florida, USA
| | - Julia Toman
- Department of Otolaryngology Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Morsani College of Medicine, University of South Florida, Florida, USA
| | - Francesco Pisapia
- Department of Maxillofacial sciences, La Sapienza Universitá di Roma, Roma, Italy
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Functional Nasal Surgery. Plast Reconstr Surg 2022; 150:439e-454e. [PMID: 35895523 DOI: 10.1097/prs.0000000000009290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: (1) understand the functional significance of nasal anatomy as it relates to rhinoplasty and perform a comprehensive functional nasal assessment. (2) Identify the anatomical level of obstruction based on the authors' algorithmic approach and understand the current evidence supporting operative techniques for correcting nasal airway obstruction from septal deformity, inferior turbinate hypertrophy, internal nasal valve collapse, external nasal valve collapse. (3) Understand the current evidence supporting operative techniques for correcting nasal airway obstruction from septal deformity, inferior turbinate hypertrophy, internal nasal valve collapse, and external nasal valve collapse. (4) Appreciate the objective assessment tools for functional nasal surgery from a clinical and research perspective. SUMMARY The intent of functional rhinoplasty is to improve nasal airflow (and the perception thereof) by surgically correcting the anatomical sources of obstruction in the nasal airway. Cosmetic and functional rhinoplasty are not mutually exclusive entities, and the techniques that address one area, inevitably may affect the another. The rate of functional problems after cosmetic rhinoplasty range from 15 to 68 percent with nasal airway obstruction found to be the most common indication for secondary surgery. The objective of this CME article is to provide readers with an understanding of the (1) functional components of nasal anatomy, (2) clinical functional assessment, and (3) the current evidence supporting corrective maneuvers for each component.
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Effects of Functional Rhinoplasty on Nasal Obstruction: A Meta-Analysis. Aesthetic Plast Surg 2022; 46:873-885. [PMID: 35099579 DOI: 10.1007/s00266-021-02741-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/18/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Functional rhinoplasty (FRP) is used to improve nasal ventilation by correcting problems with the nasal valves. It has not been systematically reviewed on a large scale. METHODS A comprehensive literature search was conducted in the PubMed, EMBASE, and Cochrane Library databases to identify studies evaluating nasal obstruction before and after functional rhinoplasty in patients with nasal valve problems. RESULTS A total of 57 cohorts from 43 studies involving 2024 patients were included in the current meta-analysis. The Nasal Obstruction Symptom Evaluation (NOSE) scores indicated significant improvement in nasal obstruction at the 1-month follow-up (WMD = 38.12; 95% CI, 29.15-47.10; I2 = 83.6%; P = 0.00), 3-month follow-up (WMD = 48.40; 95% CI, 43.16-53.64; I2 = 69.1%; P = 0.00), 6-month follow-up (WMD = 44.35; 95% CI, 36.65-52.04; I2 = 96.6%; P = 0.00), 12-month follow-up (WMD=43.07; 95% CI, 26.56-59.58; I2 = 97.9%; P = 0.00), and the last follow-up (WMD = 46.90; 95% CI, 43.92-49.88; I2 = 95.9%; P = 0.00) with respect to the preoperative baseline. The Visual Analogue Scale (VAS) scores indicated a similar trend at the 1-month follow-up (WMD = 4.68; 95% CI, 3.79-5.57; I2 = 86.8%; P = 0.00), 3-month follow-up (WMD = 4.46; 95% CI, 3.19-5.74; I2 = 93.3%; P = 0.00), 6-month follow-up (WMD = 4.91; 95% CI, 4.04-5.78; I2 = 88%; P = 0.00) and last follow-up (WMD = 4.22; 95% CI, 3.12-5.32; I2 = 97.1%; P = 0.00). Nasal obstruction was obviously relieved through rhinomanometry (SMD=0.56; 95% CI, 0.27-0.84; I2 = 0.0%; P = 0.00) but not through peak nasal inspiratory flow (PNIF) (SMD=-1.51; 95% CI, -3.10 to 0.07; I2 = 98.9%; P = 0.09). CONCLUSION FRP may have a positive effect on nasal obstruction caused by nasal valve problems. Broader and well-designed studies are needed to shed more light on the relationships in this area. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Rodrigues Dias D, Rosa F, Santos M, Castro SSE, Fertuzinhos A, Dourado N, Sousa CA, Ferreira MG. Middle Vault Changes After Humpectomy by Spare Roof Technique Versus Component Dorsal Hump Reduction. Facial Plast Surg Aesthet Med 2021; 23:156-161. [PMID: 33635138 DOI: 10.1089/fpsam.2020.0546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives: To compare the effect of two different humpectomy techniques in the internal nasal valve (INV) angle in human anatomic specimens. Methods: Seven human anatomic specimens (14 heminoses) were included. A strip of subdorsal septal cartilage was removed and, in each nose, the right side of the middle roof lied intact over and was sutured to the septal cartilage (spare roof technique [SRT]), whereas in the left side the upper lateral cartilage was folded and sutured to the septal cartilage (component dorsal hump reduction [CDHR]). The INV angle was measured pre- and postoperatively. Results: Mean age of the specimens was 69.86 (60-80) years. Five were female. CDHR resulted in a mean change of +1.71 ± 3.12° (p = 0.197), +0.62 ± 6.89° (p = 0.817) and +6.97 ± 6.84° (p = 0.036) after resection of 2, 4, and 6 mm of septal cartilage, respectively. SRT resulted in a mean change of +1.27 ± 2.37° (p = 0.207), +6.89 ± 1.19° (p < 0.001), and +12.55 ± 1.79° (p < 0.001) after resection of 2, 4, and 6 mm of septal cartilage, respectively. In SRT, the amount of septal cartilage resection presented a significant correlation with change in INV angle (r = 0.813, p < 0.001). Conclusions: In this human anatomic study, SRT significantly increased INV angle.
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Affiliation(s)
- David Rodrigues Dias
- Serviço de Otorrinolaringologia Cirurgia de Cabeça, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Francisco Rosa
- Serviço de Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Hospital das Forças Armadas-Porto, Porto, Portugal
| | - Mariline Santos
- Serviço de Otorrinolaringologia Cirurgia de Cabeça, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Sandra Sousa E Castro
- Serviço de Otorrinolaringologia Cirurgia de Cabeça, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | | | - Nuno Dourado
- Faculdade de Engenharia da Universidade do Minho, Guimaraes, Portugal
| | - Cecília A Sousa
- Serviço de Otorrinolaringologia Cirurgia de Cabeça, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Miguel G Ferreira
- Serviço de Otorrinolaringologia Cirurgia de Cabeça, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.,Hospital da Luz-Arrábida, Vila Nova de Gaia, Portugal
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9
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Wright L, Grunzweig KA, Totonchi A. Nasal Obstruction and Rhinoplasty: A Focused Literature Review. Aesthetic Plast Surg 2020; 44:1658-1669. [PMID: 32328743 DOI: 10.1007/s00266-020-01710-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/16/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND There is a significant variation in the assessment, treatment, and outcomes of nasal airway obstruction and management in the published literature. This study aimed to: (1) define key components of the nasal airway, (2) identify frequent causes of nasal obstruction, and (3) review existing treatment methods. METHODS A systematic review of the literature was performed, and 135 studies were included via the following criteria: English, human subjects, and a primary endpoint of nasal airway improvement. Exclusion criteria were: abstract only, no airway data, pediatric patients, cleft rhinoplasty, sleep apnea, isolated traumatic nasal reconstruction, and cadaveric-only or animal studies. RESULTS The relevant obstructive sites include the ENV, septum, inferior turbinates, INV, and nasal bones. Addressing the alar rim alone may be insufficient, and inspection of the lateral wall and crura may be indicated. Correction of septal deviation involves attention to the bony base. Mucosal sparing treatment of inferior turbinates improves outcomes. INVs are a major source of nasal obstruction, and treatment includes spreader grafts. The bony nasal vault can contribute to nasal obstruction, including due to surgical osteotomies. CONCLUSIONS Anatomic causes of airway obstruction include the alar rims and lateral nasal walls, deviated nasal septum, inferior turbinate hypertrophy, decreased INV angle, and narrowed nasal bones. Treatments include graft placement; septoplasty; mucosal sparing turbinectomy; and lateral wall support. Pitfalls include failing to address the bony septum, over-resection of inferior turbinates, and narrowing of the nasal vault. Appreciation of airway management during rhinoplasty will improve functional outcomes. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Lauren Wright
- Hurwitz Center for Plastic Surgery, Pittsburgh, PA, 15313, USA
| | - Katherine A Grunzweig
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Ali Totonchi
- MetroHealth System, Case Western Reserve University, Cleveland, OH, 44113, USA.
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Reevaluating the Current Model of Rhinoplasty Training and Future Directions. Plast Reconstr Surg 2019; 144:597e-605e. [DOI: 10.1097/prs.0000000000005911] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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11
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Iwanaga J, Watanabe K, Henry B, Tomaszewski KA, Walocha JA, Oskouian RJ, Tubbs RS. Anatomical study of the internal nasal branch of the infraorbital nerve: Application to Minimizing Nerve Damage With Surgery In and Around the Nose. Clin Anat 2017; 30:817-820. [PMID: 28556243 DOI: 10.1002/ca.22927] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/22/2017] [Indexed: 11/12/2022]
Abstract
The internal nasal branch of the infraorbital nerve (ION) runs down the nose and around the ala to be distributed to the nasal septum and vestibule. The aim of this study was to measure the internal nasal branch around the ala of the nose and discuss its possible relevance in clinical/surgical practice. Twelve sides from seven specimens derived from fresh frozen and embalmed Caucasian cadaveric heads were dissected. The specimens included three males and four females. The ages of the cadavers at death ranged from 65 to 84 years. The diameter of the internal nasal branch, horizontal distance from the lateral contour of the ala (Point A) to the branch (distance H) and vertical distance from the bottom part of the ala (Point B) to the branch (distance V) were recorded. Distance H ranged from -1.6 to 1.5 mm on right sides and -1.0 to 1.5 mm on left sides. The diameter of the nerves at Point A ranged from 1.3 to 1.8 mm on right sides and 1.3 to 1.6 mm on left sides. Distance V ranged from -1.5 to 1.0 mm on right sides and -2.3 to 1.1 mm on left sides. The diameter of the nerves at Point B ranged from 0.7 to 1.3 mm on right sides and 0.8 to 1.2 mm on left sides. The results of this study are the first to detail the topography of the internal nasal branch of the ION. Clin. Anat. 30:817-820, 2017. © 2017Wiley Periodicals, Inc.
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Affiliation(s)
- Joe Iwanaga
- Seattle Science Foundation, Seattle, Washington.,Department of Anatomy, Kurume University School of Medicine, Kurume, Japan
| | - Koichi Watanabe
- Department of Anatomy, Kurume University School of Medicine, Kurume, Japan
| | - Brandon Henry
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | | | - Jerzy A Walocha
- Department of Medical Education, Jagiellonian University Medical College, Krakow, Poland
| | - Rod J Oskouian
- Seattle Science Foundation, Seattle, Washington.,Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington.,Department of Anatomical Sciences, St. George's University, St. George's, Grenada
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