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Variable relationships in nasal anatomy should be considered in internal nasal valve reconstruction

In a cadaver study, researchers determined that the relationships between the upper lateral cartilage, maxilla and pyriform ligament can affect the configuration of the lateral internal nasal valve area, therefore highlighting the importance of considering these factors when planning internal nasal valve reconstruction.

The researchers studied the histologic and anatomical relationship between the lateral aspect of the upper lateral cartilages and the frontal process of the maxilla in six cadavers. Cadaver noses were dissected by open rhinoplasty, exposing the upper lateral cartilages bilaterally. To expose the perimeter of the pyriform aperture, subperiosteal dissection was done over the medial maxillae and nasal bones. Three cadavers were used to create six tissue specimens for histologic analysis, and 12 sides were analyzed anatomically.

In all specimens, the researchers found the upper lateral cartilage articulated with the frontal process of the maxilla laterally, lying deep to the coronal plane of the maxillary bone. All specimens also contained dense fibrous tissue that was consistent with a pyriform ligament between the articulating ends of the upper lateral cartilage and maxilla.

The researchers observed a variable relationship with respect to the amount of overlap between the upper lateral cartilage and the frontal process of the maxilla. In the majority of specimens, a true overlapping relationship existed, with the lateral aspect of the upper lateral cartilage found to lie under the maxilla. In other specimens, the lateral aspect of the upper lateral cartilage ended medial to the maxilla, with a variable amount of distance between articulating cartilage and bone.

The researchers stated that depending on the configuration and lateral extent of the upper lateral cartilage, different surgical techniques should be employed in treating lateral upper lateral cartilage collapse. – by Abigail Sutton

Disclosures: The researchers report no relevant financial disclosures.