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We have said that the size and shape are evaluated nasal direct inspection looking at the face and nose in front and profile view.

should be noted:

• convexity or concavity of the nasal dorsum or bridge that is the apex of the bony pyramid
• width and projection of the tip (tip)
• deviation of the nose, si es por defecto óseo o cartilaginoso  
• forma de la columela
• alas nasales
• en visión basal (worm view) se examinan las alas,orificios nasales para ver asimetrías y si hay un desvio de tabique (septum nasal)
• tipo de piel de la punta nasal y alas nasales  si es fina, media o gruesa, la piel muy fina deja ver fácilmente a los cartílagos infrayacentes a la piel, lo contrario a la piel gruesa, sebaceous oil which is very subcutaneous tissue and cartilage belies that are underdeveloped and very thin, skin and tissue overlying dermofat leave no identifying particularly cartilage of the nasal tip (nose tip .)
• nasal tip (nose tip) in static and dynamic notice if it descends or not to smile or talk, guide us about the action of muscle depressor septi nasi descending (lower) the peak in cases of hypertrophy by increasing its force of contraction and what measures we take in this regard.

PALPATION NASAL (NOSE palpation)

the nose is taken as an aesthetic unit containing subunits

As the nose an aesthetic unit has its subunits are

Back up bone and cartilage below
sidewalls.
nasal tip (nose tip)
Wings
Columela
Triangles soft cartilage where there is extra skin and intranasal juxtaposed.


From a view basal (view worm) found the

C olumela ranging from nasal tip to the lip, attaching the lip on the top of the filter labial ( philtrum) and separating the nostrils (external nares ). His back is wider than the previous due to the divergence of the " medial crus" of the alar cartilages . The edge of the columella depends on the form and degree of divergence of these cartilages in lower portion is called here feet wing (wing feet).

PALPATION

With the patient standing or sitting is appropriate to the nasal palpation and adjoining areas:

starts at:

Back and side walls bone in nasal root in the nasofrontal angle to feel the thickness of the skin, if thin, thick, oily, dry and underlying bony structures.

Palpate the bony nasal dorsum , to feel in nasal root (radix ) and around the back bone if vertex of the bony pyramid is thin, thick, broad, deep, irregular or not, or if the nasofrontal angle is open or closed, if the frontal bone at its junction with the nasal bones is wide, it is sharp or not, if the nasal bones themselves and side walls formed by the upward apophysis the maxillae have a base open or closed and whether these side walls are symmetrical or uneven surfaces, bone spicules or poorly consolidated fault lines to walls lateral ventilation obstruct or compromise the aesthetic nasal . O lines to tangible and visible fractures at the base of the pyramid (SLEP ladder )

Or if there is a backup wide, flat or sharp edges (roof open ) product of a surgical fracture or not.

And we got to the junction (junction) or osteocartilaginous union of the nasal bones to the lateral cartilage.

cartilage Back

same maneuver is performed and checked whether or not the junction osteocartilaginous hump (dorsum convex, outstanding) in the nose area is very mobile.

Also if at the top and side walls of lateral cartilage (upper) are symmetrical or are sunken or protruding somewhere on their anatomy.

In the distal part of the lateral cartilage (above) can touch and sometimes see the septum (cartilaginous septum ) at its apex that lifts the skin as a store.

nasal tip (nose tip)

short: is the distal and the nose is formed by two alar cartilages on each side, Each cartilage has the following parts, the medial cross your foot wing , wing knee and lateral cross , both knees are the domus, which is one of the most important the nose from the point of view of a rhinoplasty , nasal tip.

The nasal tip (nose tip ) includes domus ( Alar dome ) is where you join both knees wing (genu wing ) the medial cross and lateral cross of the alar cartilages.

is simply the junction of the medial cross and cross lateral cartilage both (right and left) and is separated from the margin of the nostrils an area so triangular triangle known as soft (triangle soft ) .

On palpation, in fine leather leptorhines , we feel its consistency and elasticity curves

and up the groove interdomal ( space between wing both knees), and you still feeling inside in the vestibule (vestibulum ) we can easily continue to touch most of the lower edge of the lateral cross and clamping bidigital index inside the lobby and thumb out, and experience with the toe curve domus and feel even to the interdomal groove (sulcus interdomus ) separating the knees wing and medial cross .

Feeling the columella follow the entire length of the medial cross and its bifurcation or divergence of distal end showing the foot wing (wing feet) on the inside (medial) of the nasal floor.

Suprapunta (supratip area)

is the area where they join the distal part of the lateral cartilages, the upper edge and vertex of cartilaginous septum (septum) and proximal edges (above) of the alar cartilages forming a "V". This triangular-shaped area called the triangle weak (weak triangle)

The weak or weak triangle triangle

is called well as the septal angle maintains, supports the back area between the diverging medial cross and holds it up by ligamentos.

 La cruz lateral de los alares en la zona de la suprapunta ( supratip area ) en su divergencia forma una zona triangular donde el ángulo septal se entalla, cabe en el vértice de esa "V".

En muchas narices, esa zona de la punta solo es soportada por el ángulo septal que muchas veces se palpa y estas estructuras se mantienen juntas y sostenidas entre si por el Ligamento suspensorio de la punta (Suspensory ligament of the tip).

To check whether the nasal tip ( nose tip) is well supported or not, makes the following maneuver, push down and back, and observe, if the move was easy and did not offer much resistance and the return of the tip was no natural place to stop almost instantaneous pressure indicates that , the point needs a good support (cartilage) to hold and prevent it from falling post-surgery.

nostrils

Palpation checks and l thickness of the skin is very thick and oily in platyrhine and mestizos with little or no cartilage palpable round nasal tip, thick bulbous tissue dermofat, short columella and nostrils flatten.

mesorhine In (Eastern) her nose is smaller, round tip, nasal lobe lower and wider than leptorhines .

leptorhines In as we have said can be felt and even see the outline of nasal tip cartilages , your nostrils are vertical and oblique.

REVIEW Endonasal
(endonasal EXAMINATION)

With the patient lying down and the chin lifted discussed in view and observe the basal diameter nostril and eye, raising a finger tip can check:

• diversion nasal septum (septal cartilage or bone)
• perforated septum
• constrained internal nasal valve

• hypertrophied inferior turbinate or middle,
• congestive nasal mucosa, red
• anomaly of position of the alar and triangular cartilage (above) or the bridge
• nasal obstruction, to prove there is a simple test that involves occluding one nostril and listen and appreciate the passage of air breathing through the other nostril.
• nasal speculum and good light: is introduced to review and confirm all the above intranasal structures and perform a preoperative clinical diagnosis.

have any questions, requested to ray examination, CT or resonance imaging (MRI) or videoendoscopy diagnostic and assistance of a specialist, especially one Otolaryngologist (ENT)

; PHOTOS

routine with a good camera, taking pictures of front, left and right profile, right and left anterior oblique and basal (worm view). Used to assess changes in the short, medium and long term certified with photos taken in the immediate postoperative period, mediate and long term.

IMAGE SOFTWARE

With this software can display the photos taken at the / patient, the changes will be made with rhinoplasty and displayed on a large screen for a good display and discuss them for a reasonable consensus on the outcome.
We must remember that these images are two dimensional and that the face and nose have 3 dimensions (height, width and depth).