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Anatomy of the Nose

Complex in both form and function, the nose is the anchor of the face playing an important role in each individual's appearance. Facial plastic surgeons such as Dr. Rizk are experts in understanding the anatomy of the nose but it is helpful for patients considering rhinoplasty to also have a basic knowledge of nasal structure.

Essentially, nose anatomy can be divided into two parts: the external, the part that protrudes from the face and is visually seen, and the internal, which comprises the nasal cavities that connect with the sinuses located under the forehead and cheekbones.

External Nasal Anatomy

Let's start with the external anatomy of the nose. Externally the nose is primarily a three sided pyramid. Composed of bones and cartilages, the framework of the nose is covered with skin that is lined with mucous membrane. The bones in the upper part of the nose act as a support structure. The nasal bridge (or dorsum) is formed by two nasal bones that are joined in the center. On the sides of the nose, the nasal bones are connected to the face by a fibrous membrane. At the base, nasal cartilage connects the nasal bones.

The lower part of the nose is made up of cartilages that form the tip of the nose and nostrils. The cartilage at the tip of the nose is actually made up of five pieces that are connected by membranes. The two nostrils are separated by the septum, which is made of cartilage covered by membrane. The vertical structure located between the two nostrils that attaches the nasal tip to the upper lip is called the columella. The columella contain soft tissue as well as parts of the cartilages that form the nasal tip called lower lateral cartilages. The structures that attach the nostrils to each side of the cheeks are called alae.

The nostrils and nasal cavity are lined with mucous membrane and cilia. The mucous secreted by the mucous membrane filters the air while the cilia (little hairs) prevent microorganisms from entering the body.

Internal Nasal Anatomy

The internal nasal structure or nasal cavity houses both the system whereby we are able to smell and the top most part of the respiratory system. Also called olfaction, the process of smelling begins with inhaling. Air is pulled through the nostrils from the outside of the body and into the nasal cavity. The top side of the nasal cavity is located directly under the brain, separated from it by a thin wall of bone and mucous membrane. Located on that membrane is a small area called the olfactory bulb that contains millions of olfactory receptor nerves. These are the nerves that differentiate between thousands of individual smells.

The nose is the air filter and conditioner for your lungs. As mentioned, the cilia or hairs keep out dust and microscopic particles. The nasal cavity has shelves and folds that warm the air and add moisture to it before reaching the lungs, making breathing much more comfortable. These shelves are called turbinates. The lowest most turbinates close to the entrance of the nostrils are called inferior turbinates. When the inferior turbinates are enlarged (which occurs with allergy) they can cause difficulty breathing. The turbinates in the middle part of the nose are called the middle turbinates. The middle turbinates are involved with sinusitis or sinus blockage if enlarged. Concha bullosa is an air cell in the middle turbinate which enlarges it and causes it to block the sinus openings.

The sinuses, which are also lined with mucous membrane, humidify and warm the air too. Basically empty spaces in the nasal and facial structure, sinuses reduce the weight of the skull and facial bones and increase the resonance of the voice.

The nasal cavity is also connected to the middle ear by the Eustachian tubes, which run down from the middle ear into the nasal cavity at the top of the throat. This close proximity explains why a cold or bacterial infection can hit you in the ears, nose and throat simultaneously or in sequence. The purpose of the Eustachian tubes is to equalize the pressure between the middle ears and the outside.

A careful understanding of the anatomy of the nose is required by a surgeon performing an primary or a revision rhinoplasty. If you have any questions regarding the structure of the nose, be sure to ask your surgeon for clarification.

Dr Sam Rizk is a double board certified facial plastic surgeon who is an expert in internal nasal structures (board certification in ENT) and external nasal structures (board certification in facial plastic surgery). This is important for a nose surgeon to have both ENT and Facial plastic surgery certification because internal anatomy of the nose are intimately associated with external anatomy and structure and very often, especially in revision rhinoplasty, abnormalities or collapses in external anatomy impinge on internal anatomy and cause difficulty breathing. Likewise, internal abnormalities can affect external shape and structure of the nose. A general plastic surgeon, not certified in ENT does not have this expertise. Also, deviations of the internal nasal structures such as the septum can also affect external deviations of the nose and repairing the internal structures helps to obtain a straighter nose.