94 / 242
CHAPTER 4: Midfacial Trauma
Resident Manual of Trauma to the Face, Head, and Neck
92
3. Neurovascular (Figure 4.9)
y
y
Lateral nasal and septal arteries, from facial artery (external carotid).
y
y
Dorsal nasal artery, from ophthalmic artery (internal carotid).
y
y
Sensory innervation from trigeminal nerve:
•• Root and dorsum from ophthalmic (V1).
•• Sidewall, mostly from maxillary (V2).
Figure 4.9
Nasal vascular anatomy.
4. Conformational
y
y
Pyriform (“pear-shaped”) aperture:
•• Bordered by nasal bones, maxilla.
y
y
Soft tissue envelope.
y
y
Skin externally (abundantly sebaceous) and internally, vestibule
(hair-bearing “vibrissae”).
y
y
Mucous membrane lining internal to vestibule (border is
limen
vestibuli
).
y
y
Fibrofatty tissue works with cartilages and bone to maintain
conformational integrity.
•• Upper vault, mostly bony, is rigid.
•• Lower vault, mostly cartilaginous, fibrofatty, is flexible, performs
valve function.
•• Paired nostrils (nares) with intervening columella containing
medial crura of lower lateral cartilages.
5. Orientational Terminology (Figure 4.10)
y
y
Dorsal: toward “bridge.”
y
y
Cephalic: toward top of head.
y
y
Caudal: toward mouth.
Figure 4.10
Nasal orientational terminology.