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Background: Knowledge of tip supporting structures is crucial for successful rhinoplastic surgery. The aim of this study was to provide detailed anatomical and histological descriptions of the tip supporting structures., Methods: Serial coronal sections of the entire external noses from seven cadavers were studied after staining by Mallory-Cason and Verhoeff-Van Gieson procedures., Results and Conclusions: We found no histological evidence of ligaments between the cartilaginous- and bony parts of the nasal skeleton, and between the skin and the nasal skeleton. Instead, we found a perichondrial-periosteal lining within the soft tissue envelope. The main tip supporting and shaping structures are: septal and lobular cartilages, premaxillae, and the soft tissue envelope including the periosteal-perichondrial envelope/membrane. These findings may have clinical relevance in functional and aesthetic rhinoplasties.

The periosteum of the nasal bones, the periosteal-perichondrial nasal envelope, and the cartilaginous support of the bony vault were studied in serial coronal sections of four human cadaver noses. To differentiate between the various tissue components, the sections were stained according to Mallory-Cason and Verhoeff-Van Gieson stain. The results demonstrated: 1. the presence of clearly distinguishable layers of the periosteum covering the nasal bones; 2. the presence of a continuous periosteal-perichondrial covering of the bony and cartilaginous nasal vaults; 3. the way the cartilaginous support of the bony vault is constructed. The findings described in the present study may have clinical relevance in nasal surgery.

At least 13 surgical techniques have been used over the past 130 years to treat hypertrophy of the inferior turbinate. These methods are reviewed and critically analyzed in this article. Our review of the literature revealed a serious lack of qualified studies. Research meeting the criteria for a prospective comparative randomized surgical study is extremely rare. In our opinion, the purpose of surgically reducing the inferior turbinates should be to diminish complaints while preserving function. From that perspective, it seems that electrocautery, chemocautery, (subtotal) turbinectomy, cryosurgery, and laser surface surgery should not be used, as these techniques are too destructive. Intratubinal turbinate reduction (intraturbinal turbinoplasty) would seem to be the method of choice.

Although the gross anatomy of the nasal septum is well-understood, the exact anatomy of its ventrocaudal or premaxillary area is not. More precisely, there is some confusion about the course of the perichondrial and periosteal fibers in this particular region. This paper considers the detailed anatomy of the chondro-spinal and chondro-premaxillary junction. Six cadaver noses were sectioned in the coronal (n = 4) or the transverse (n = 2) plane. The sections were stained according to the Mallory-Cason and the Haematoxylin-Eosine method and examined by light microscopy. At the chondrospinal junction a relatively wide suture line filled with loose connective tissue fibers was found. The caudal margin of the cartilaginous septum is flanked by paraseptal cartilages. These broaden the septal base to fit onto the flat cranial surface of the anterior nasal spine. At the chondro-premaxillary junction a narrow suture with several crossing fibers between the perichondrium and periosteum was seen. Paraseptal cartilages, surrounded by their own perichondrium, cover the periphery of this area. It was concluded that the chondro-spinal junction provides stabilization while allowing some mobility of the septum, whereas the chondro-premaxillary complex stabilizes the septum without allowing mobility.

Some authors consider the interdomal ligament to be an important structure of nasal tip support, whereas in other studies of lobular anatomy such a ligament is not mentioned at all. To clarify this question, we performed an anatomical investigation, which included macroscopical dissection and histological sectioning of 14 human cadaveric noses. Our anatomical study failed to reveal the presence of an actual ligament in the interdomal area.

The aim of this study was to explore the usefulness of two different in vitro models for studying the function of human upper respiratory cilia, i.e. cell suspension cultures of human upper airway epithelium, and ciliated adenoid epithelium. Ciliary beat frequency (CBF) and signal consistency (SC), as parameters of ciliary function, were measured by a computerized photo-electrical method. Measurements after one week revealed that CBF of ciliated aggregates from cell suspension cultures had deteriorated to a mean of 5.8 Hz. In the subsequent period, it remained at this rather low and non-physiological level. SC decreased too, although not as dramatically. These results indicate that ciliated aggregates from cell suspension cultures cannot be used for human ciliary function experiments in vitro. On the other hand, in ciliated adenoid epithelium, CBF remained constant for a period of 5 h, although SC decreased after 30 min. Because of this result and the fact that ciliated adenoid epithelium is easily obtainable, we regard this material as suitable for studying human ciliary beat in vitro.

The effect of autonomic substances on ciliary beat in mucosal biopsies from the normal human nose was studied. The influence on ciliary beat frequency (CBF) as well as on ciliary beat harmony was measured photoelectrically. The sympathetic beta-agonist isoprenaline was found to have a stimulatory effect on CBF, whereas the alpha-agonist xylometazoline reduced CBF and ciliary beat harmony. The parasympathetic agonist carbachol had a positive effect on CBF. The sympathetic antagonists timolol (beta) and phentolamine (alpha) as well as the parasympathetic antagonist atropine had no effect. The effect of the agonists on ciliary beat was absent when they were administered in combination with their specific antagonists. These experiments indicate that, in clinical concentrations, the autonomic substances modify ciliary beat by a direct effect on the ciliated cells.

Investigation of the effect of environmental and pharmacological factors on human respiratory epithelium requires standardization of measuring conditions. Ciliary beat frequency (CBF) and its shift were determined photo-electrically in 43 biopsies of human nasal mucosa. Curette biopsies were compared to forceps biopsies. CBF variation between three different cells of one biopsy sample did not differ for the two biopsy techniques. The ciliated cells of forceps biopsy specimens showed a more constant beating pattern which resulted in a small CBF shift. It appeared that in studying ciliary activity a continuous layer of ciliated cells which is in contact with the basal membrane is required. Therefore forceps biopsies are preferable to curette biopsies. The environmental temperature has to remain constant since CBF is temperature dependent. The pH and osmolarity of the medium do not influence CBF when kept within a certain range. No effect of medium superfusion flow rate was seen.

Anatomic relations in the nose and paranasal sinuses have been studied in computer tomographic images and cryosections, to highlight some details that are of importance for the functional nasal surgeon. From three heads the sections were obtained in three perpendicular planes (coronal, axial and sagittal). The most interesting sections are depicted in three ways: a computer tomographic image, the surface photography of the tissue block in the microtome and a stained section of 20 microns. A number of interesting relations that are clearly depicted are discussed.

A technique of wedge resection is used for reduction of an extreme projection of the bony nasal pyramid. In these cases the push-down technique is inadequate, and resection of the dorsum is considered too destructive. The method consists of the resection under direct vision of a bony triangle at the base of the bony pyramid. To this end, a subperiosteal tunnel about 7-8 mm wide is created on the lateral and medial surface of the nasal bones via vestibular incisions.

The long term results of our two first cases of septal reconstruction in the acute phase of a septal abscess in childhood are described. Follow-up periods were 19 and 17 years respectively. The development of the nasal pyramid was normal apart from a slight to moderate sagging of the cartilaginous dorsum. Length, width and prominence developed within normal limits and nasal function remained undisturbed. Reconstruction of the septum in the acute phase of a septal abscess seems also on the long term effective in preventing the well known disturbance of growth, form and function of the nose.

This paper summarizes the author's experience with septum surgery in children from 1963 to 1978. Some 150 children have been operated upon and many of them could be followed up. A septal deformation with breathing problems at rest is an indication for conservative surgery regardless of the patient's age. If there is only breathing difficulty during exercise, other factors (age, external deformity, psyche) play a role in making the decision. Septal deformities without functional complaints are left untouched. The prevention of a growth deformity can be a concomitant factor in deciding whether to operate. Fresh fractures, septal haematoma's and abscesses are undisputable indications for surgery. The surgical technique as used in the two most frequent types of deformation is described. A boy operated upon at the age of 4 was followed-up over a period of 15 years. His nose developed normally until puberty. Then some growth disturbance became apparent.