Nasofacial Angle Research Articles

Correlation between anthropometric facial features and characteristics of nasolacrimal drainage system in connection to false passage

To determine the correlation between the anthropometric facial features and the anatomy of the nasolacrimal drainage system. Forty-six mid-sagittal halves of 23 cadavers were studied. The inclination of the lacrimal sac (LS) and nasolacrimal duct (NLD), and the LS-NLD angle were measured in both the sagittal and coronal planes. For the facial features, the height, length and depth of the nose, the intercanthal distance, nasal breadth, nasofacial angle, distance between the external naris, and the inferior aperture of the NLD were measured. The correlations between the angles and the facial features were calculated. The LS-NLD angle was classified into three anatomical types according to the inclination of the LS and the NLD in the sagittal and coronal planes; the anterior-inward type (43.5%), anterior-outward type (37.0%), and posterior-outward type (19.5%). The nasal depth was correlated with the sagittal LS-NLD angle, and the nasal height and length were correlated with the coronal LS-NLD angle. There is a large variation in the LS-NLD angle, and nasal depth, height and length can be used to predict the direction of this angle.

A comparison of aesthetic proportions between the healthy Caucasian nose and the aesthetic ideal

The aim of septorhinoplasty is to create a nose that is aesthetically pleasing to the patient and to maintain nasal function. Although a small number of population cohort studies have been performed on the ethnic nose, little is known of the aesthetics standards of nasal proportions in the general Caucasian population. The aim of this study was to establish parameters of the average nose in the healthy population and to compare them with those of the aesthetic ideals. Ethical approval was obtained to recruit a cohort of staff and students from the medical school. Two photographs were taken: anterior and right lateral. The following measurements were made: intercanthal width, alar width, length of the nose (nasion-pronasion length), naso-labial angle, nasal tip projection, naso-facial angle and naso-frontal angle. These parameters were compared with published aesthetic ideals. Aesthetic nasal proportions of 50 healthy Caucasians were examined from a cohort of 57 volunteers. Results showed that the average nose did not conform to neo-classical facial canons. The alar width (average 3.6 cm) was significantly wider than the intercanthal width (average 3.0 cm, p<0.05). The nasal width-length ratio was also greater suggesting that the cohort average was shorter and wider than the aesthetic ideal. The Baum ratio was 2.5:1, indicating that the average nasal tip was more projected that the aesthetic ideal (2.8:1). The naso-frontal and naso-facial angles are both more obtuse, and in profile the average nose overall appeared more prominent, as a result of the reduced forehead projection. The only parameter where there appeared to be consistency between the average and the ideal nose was the naso-labial angle. This study shows that many aesthetic parameters from a cohort of healthy subjects differ from the widely used aesthetic standards. Rhinoplasty surgeons should, therefore, give thought to the frame of reference used when discussing aesthetic objectives with their patients.

Alar setback technique: a controlled method of nasal tip deprojection.

To describe an alar cartilage-modifying technique aimed at decreasing nasal tip projection in cases with overdeveloped alar cartilages and to compare it with other deprojection techniques used to correct such deformity. Selected case series. University and private practice settings in Alexandria, Egypt. Twenty patients presenting for rhinoplasty who had overprojected nasal tips primarily due to overdeveloped alar cartilages. All cases were primary cases except for one patient, who had undergone 2 previous rhinoplasties. An external rhinoplasty approach was used to set back the alar cartilages by shortening their medial and lateral crura. The choice of performing a high or low setback depended on the preexisting lobule-to-columella ratio. Following the setback, the alar cartilages were reconstructed in a fashion that increased the strength and stability of the tip complex. Subjective evaluation included clinical examination, analysis of preoperative and postoperative photographs, and patient satisfaction. Objective evaluation of nasal tip projection, using the Goode ratio and the nasofacial angle, was performed preoperatively and repeated at least 6 months postoperatively. A low setback was performed in 16 cases (80%) and a high setback in 4 (20%). The mean follow-up period was 18 months (range, 6-36 months). The technique effectively deprojected the nasal tip as evidenced by the considerable postoperative decrease in values of the Goode ratio and the nasofacial angle. No complications were encountered and no revision surgical procedures were required. The alar setback technique has many advantages; it results in precise predictable amounts of deprojection, controls the degree of tip rotation, preserves the natural contour of the nasal tip, respects the tip support mechanisms, increases the strength and stability of nasal tip complex, preserves or restores the normal lobule-to-columella proportion, and does not lead to alar flaring. However, the technique requires an external rhinoplasty approach and fine technical precision.

Lateral crural steal and lateral crural overlay: an objective evaluation.

To assess objectively the effect of 2 cartilage-modifying techniques, lateral crural steal (LCS) and lateral crural overlay (LCO), on the degree of nasal tip projection and rotation. A prospective trial using computer imaging techniques for assessment. Half of the patients were seen at a university hospital and the other half at a private practice. A selected series of 30 patients seeking rhinoplasty mainly for nasal tip repositioning. Only patients with no history of previous nasal operations were included. All patients were operated on using an external rhinoplasty approach. Only 1 of the 2 techniques was adopted for each patient. The technique selected depended purely on clinical judgment. The nasofacial angle and the Goode ratio were used to assess tip projection, and the nasolabial angle and rotation angle were used to assess tip rotation. The use of the LCS technique resulted in an increase in both nasal tip projection and rotation, but the use of the LCO technique resulted in an increase in tip rotation and a decrease in tip projection (P<.001). Additionally, the LCO technique resulted in significantly higher degrees of rotation than the LCS technique (P<.001). The LCS procedure is indicated when a moderate increase in nasal tip projection and rotation is desired. The LCO technique is useful in patients where severe underrotation is associated with overprojection.

The Short Nose

Lengthening the short nose is arguably the most difficult operation in aesthetic rhinoplasty. Open and closed operative techniques can achieve absolute lengthening. In the open technique, maximum lengthening is achieved by releasing the mucoperichondrium, which has to be elevated bilaterally from the septum; releasing the soft tissue between the upper and lower lateral cartilages; and attaching a batten graft to the septum to project the tip cartilages caudally. The closed technique uses a hemitransfixion incision and elevation of the mucoperichondrium bilaterally, followed by attachment of a batten graft. The apparently short nose also can be treated by derotating the tip, correcting the columellar labial angle, and altering the location of the nasion as well as the nasofacial angle.

NEW INSTRUMENTS FOR USE IN RHINOPLASTIC SURGERY

The following new instruments have been devised to aid the rhinoplastic surgeon in obtaining better results with the least possible trauma and in the shortest time. They are also intended to solve some difficult problems with which the surgeon may be confronted. They are (1) a perforated saw guide, (2) a periosteal elevator and saw director, (3) a nasal chisel, (4) an alar forceps and (5) a nasal saw director. The perforated saw guide (fig. 2) is intended for use only by the beginner who experiences some difficulty in securing the saw in the desired position along the nasofacial angle of the nose. When the saw guide is placed at the nasal-facial angle or at the internasal suture line the saw is permitted to enter the perforation in the instrument. The guide is then held securely with the left hand, and with the right hand the surgeon can saw through