A lot of things occur under the surface of the nose. The bone and cartilage give the nose most of its size and shape. Various other structures inside and behind the nose help you breathe.
To be precise, the bone supports the nose bridge, the upper cartilage supports the side of the nose, and the lower cartilage adds support, width, and height. It helps shape the nostrils and the nose tip. The skin also helps shape the nose.
Learning the anatomy of the nose can assist you in understanding how the nose works. The more you know, the better especially if you are considering Nasal cartilage reconstructive procedures for function, fashion, or both.
What is Nasal Cartilage?
The nasal cartilages are anatomical structures within the nose that provide shape and support to the nasal cavity. They are composed of a flexible material called hyaline cartilage, densely packed with a structural protein called collagen in the distal portion of the nose. The function of the cartilage and the loads placed on it varies depending on the positioning.
The inferior portion of the nose is composed of hyaline cartilages; lateral, major alar, minor alar, and the cartilaginous septum. The largest cartilages are the lateral and major alar and majorly contribute to the shape of the nose. The minor alar cartilages consist of 3 or 4 parts on each side.
Types of Nasal Cartilage
The nasal cavity is made up of five individual cartilages.
Septal Nasal Cartilage
The septal nasal cartilage (lateral cartilage, upper lateral cartilage) is a flat and triangular-shaped hyaline cartilage located below the inferior margin of the nasal bone. The anterior margin is thicker than the posterior margin and extends above with the cartilage of the septum but detached from it at the bottom by a narrow fissure. The superior margin of the cartilage is connected to the nasal bone. The inferior margin and the frontal process of the maxilla are connected to the greater alar cartilage by fibrous tissues.
The septal nasal cartilage divides the right and left nasal cavities, letting air pass through them. The two cavities generate turbulence between the tight spaces, allowing the quick flow of the air bidirectionally. The septal nasal cartilage being the midline structure of the organ, also provides the orientation of the nose.
Lateral Nasal Cartilage
The lateral cartilage (upper lateral cartilage, lateral process of septal nasal cartilage) is located inferior to the nasal bone. It is flat and triangular-shaped.
When the lateral nasal cartilage contacts the major alar cartilage, it curls up, forming a close connection through fibrous tissues. It is composed of hyaline cartilage that provides shape and flexibility within a specific structure.
Major Alar Cartilage
The major alar cartilage (greater alar cartilage, lower lateral cartilage) is a thin, flexible plate located immediately below the lateral nasal cartilage. It is connected superiorly to the lateral nasal cartilage through fibrous tissues. It is composed of hyaline cartilage that is thin and folded and forms the lateral and medial crus.
The medial crus (the inner portion of the major alar cartilage) is located vertically to the septal nasal cartilage. The lateral crus (the outer portion of the major alar cartilage) links with the nose’s ala.
When both the crus come together, there is the formation of an oval tip at each nostril. Both sides of the major alar cartilages meet to form a notch at the tip (apex of the nose). The medial and lateral walls inside the nares allow the major alar cartilages to hold open each naris, resulting in maximal airflow to reach the nasal valve for optimal respiration.
Minor Alar Cartilage
The minor alar cartilage (lesser alar cartilage, sesamoid, or accessory cartilage) are a few small pieces of hyaline cartilage on both sides of the nose located between the lateral nasal cartilage and the major alar cartilage. These small structures are held within the most dorsal part of the ala. These structures help provide shape and strength at the base of the nares and connect with the major alar cartilage.
The vomeronasal cartilage (Jacobson’s cartilage) is a narrow strip of hyaline cartilage between the septal nasal cartilage and the vomer. The cartilage lies below and provides strength and structure.
Top 3 Reconstructive Procedures for Nasal Cartilage
Cartilage can get damaged after an injury, through degeneration or a condition present at birth, which wears down over time. Damaged or injured cartilage does not repair itself and will not heal well without medical intervention.
With emerging advancements in technology, surgical and reconstruction techniques have been developed to align with the lifestyle and health of individuals.
Rhinoplasty procedures have become more common, including septoplasty, sliding alar cartilage, and upper lateral cartilage repositioning. These procedures are used for cosmetic and functional issues involving the nose.
Septoplasty is a surgical procedure that realigns the septal nasal cartilage and restores a person’s ability to breathe properly. Septoplasty procedures do not alter the external appearance of the nose. Still, septo-rhinoplasty procedures can correct the septum’s internal alignment and enhance the external aesthetic appearance of the nose for facial harmony.
Sometimes, external changes are required to help with respiratory issues. For instance, if the nose has been injured or has had surgery in the past for some reason, it may often be necessary to place cartilage grafts taken from the septum, the ear, or the rib, to reconstruct the nose to give it better function. It will allow the patient to receive more airflow through the nostrils when the surgery completely heals after 3 to 6 months.
However, there are some associated risks with this procedure. It includes altered shape of the nose, excessive bleeding, vacant space in the septum, blood clots that need to be removed, trouble smelling, and numbness in the facial region. Smoking during the healing process can also cause further damage.
An extensive evaluation of the internal and external nose is performed during the consultation, and a CT scan is performed to investigate the septum in its entirety and the sinuses.
Upper Lateral Cartilage Repositioning
The upper lateral cartilage repositioning procedure moves the lateral nasal cartilage from obstructing the nasal valve. The nasal valve is the smallest passage within the nose and is commonplace for obstruction. This procedure helps resolve issues involving lateral nasal cartilage deformities.
There are other surgical procedures to open up this airway by using grafts to separate the septal nasal and lateral nasal cartilages from each other. Permanent grafts are often used.
The cartilage repositioning technique uses a temporary stent that repositions the lateral nasal cartilage, allows it to heal or be stationary due to scar tissue formation, and then removed. Being an open rhinoplasty procedure allows the nose to heal to an optimal position without any permanent artificial device.
Sliding Alar Cartilage (SAC)
The greater alar cartilages can get very weak or have deformities, resulting in respiratory issues. It may also lead to both functional and aesthetic problems. Some surgical procedures, such as alarplasty, reshape the greater alar cartilages utilizing grafts or through cartilage re-sectioning.
The sliding alar cartilage procedure helps strengthen and support the nasal tip. This technique also reshapes the nasal tip.
The sliding alar cartilage procedure is accomplished within two to three minutes as part of the open rhinoplasty approach. During this timeframe, the nose tip is cut open. The greater alar cartilage is manipulated to maintain the curl area to provide strength and structure, and then the incision is sutured. This simple technique creates a definition of the nose tip while maintaining airway function.
Though there are various other procedures to strengthen the greater alar cartilage, the SAC technique is gaining momentum to create natural-looking nasal tips.
The Bottom Line
Researchers are still exploring new ways of treating and healing damaged cartilage besides increasing blood supply and performing cartilage grafts. Clinical trials are underway, including using stem cells to grow into healthy cartilage and create a microgel to nourish the cartilage.
Nevertheless, these approaches will take time and testing before the emergence of new techniques.