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dibonacomemorials Group

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Efrem Savin
Efrem Savin

Anterior Naris

Anterior nares are the external (or "proper") portion of the nose. The anterior nares open into the nasal cavity and allow the inhalation and exhalation of air. Each is an oval opening that measures about 1.5 cm anteroposteriorly and about 1 cm in diameter.

anterior naris

The anterior nares are commonly infected by Staphylococcus aureus (also known as "golden staph") which may contribute to dermatitic skin lesions in patients with atopic dermatitis.[1] The anterior nares can act as a colonizing point from which the infection can spread.[2] This can be particularly troublesome if the strain is an antibiotic resistant (commonly MRSA or ORSA) strain. MRSA (first discovered in the UK in 1961) has become particularly widespread in hospitals and is commonly considered a superbug. For more information on symptoms and treatment see MRSA.

The anterior (or external) nares (singular: naris) (a.k.a. nostrils) are openings that form the entrance to the nose. Each naris is formed by a ring of structures:

Gently insert a nasal speculum and spread the naris vertically. This permits visualization of most anterior bleeding sources. Approximately 90% of nosebleeds can be visualized in the anterior portion of the nasal cavity. Massive epistaxis may be confused with hemoptysis or hematemesis. Blood dripping from the posterior nasopharynx confirms a nasal source.

Traditional anterior nasal packing with petrolatum gauze has largely been supplanted by the use of tampons and balloons, which are readily available and more easily placed. This method is commonly performed incorrectly, using an insufficient amount of packing placed primarily in the anterior naris. When placed in this way, the gauze serves as a plug rather than as a hemostatic pack. Physicians inexperienced in the proper placement of a gauze pack should use a nasal tampon or balloon instead.

Continue this process, layering the gauze from inferior to superior until the naris is completely packed. Both ends of ribbon must protrude from the naris and should be secured with tape. If this measure does not stop the bleeding, consider bilateral nasal packing.

Trim the compressed sponge (eg Merocel) to fit snugly through the naris. Moisten the tip with surgical lubricant or topical antibiotic ointment. Firmly grasp the length of the sponge with a bayonet forceps, spread the naris vertically with a nasal speculum, and advance the sponge along the floor of the nasal cavity. Once wet with blood or a small amount of saline, the sponge expands to fill the nasal cavity and tamponade bleeding (see the images below).

After passing the posterior balloon through the naris and into the posterior nasal cavity, inflate it with 4-5 mL of sterile water, and gently pull it forward to fit snugly in the posterior choana. After bleeding into the posterior pharynx has been controlled, fill the anterior balloon with sterile water until the bleeding completely stops. Avoid overinflation, because pressure necrosis or damage to the septum may result. Record the amount of fluid placed in each balloon.

If a Foley catheter is used, place a 12-16 French catheter with a 30-mL balloon into the nose along the floor of the nasopharynx, until the tip is visible in the posterior pharynx. Slowly inflate the balloon with 15 mL of sterile water, pull it anteriorly until it is firmly seated against the posterior choanae, and secure it in place with an umbilical clamp. Use a buttress clamp with cotton gauze to avoid pressure necrosis on the nasal alae or columella. Finally, place an anterior nasal pack.

Absorbable materials such as oxidized cellulose (Surgicel), gelatin foam (Gelfoam), and gelatin and thrombin combination (FloSeal) are suitable alternatives to nasal packing for anterior bleeds. [17] They directly tamponade bleeding sites, increase clot formation, and protect the nasal mucosa from desiccation or further trauma. They are easy to use and comfortable and conform to the irregularity of the nasal contours. [18, 19]

Patients discharged from the hospital with anterior packing should receive follow-up care with an otolaryngologist within 48-72 h. Nasal packing prevents drainage of sinuses and increases the risk of sinusitis or toxic shock syndrome.

Sordes > PterorhynchusBetween Sordes and Pterorhynchus the naris was drastically reduced (Fig. 1) as the antorbital fenestra increased its length. The antorbital fenestra extended anteriorly beneath the naris for half of its length in both cases. It is difficult to determine if a naris was present or not in Kunpengopterus through Wukongopterus, sisters to Darwinopterus.

Scaphognathus > Germanodactylus and PterodactylusBetween the n109 specimen of Scaphognathus and Germanodactylus rhamphastinus there appears to be a reduction and splitting of the naris into a primary naris (posteriorly) and a secondary naris (anteriorly). The nasal and jugal appear to extend to the anterior (secondary) naris.

Scaphognathus > Cycnorhamphus and ZhenyuanopterusBetween the n110 specimen of Scaphognathus and Cycnorhamphus and Zhenyuanopterus the pattern of narial reduction duplicates the previous pattern. Often in ornithocheirids the tiny anterior naris is completely eliminated by bone growth sealing the opening.

Dorygnathus > ZhejiangopterusIn Dorygnathus through Zhejiangopterus the naris became smaller and moved anteriorly. Several holes appeared in derived skulls, but these could be artifacts and/or erosion.

Naris? Or Skull Erosion?The difficulty in searching for the naris lies in trying to determine what is a tiny naris and what is a tiny gap or erosion of the bone. The nearby anterior processes of the nasal and jugal provide some guide, but the evidence is often equivocal. Comparisons to sister taxa are also helpful. In any case, I see no evidence for erosion of the maxillary process meeting the nasal that separated the naris from the antorbital fenestra. Thus there was no confluence.

The Reduction of the Naris in BirdsSeveral birds, like the diving gannett (Sula bassana), pelican (Pelicanus) and the sifting spoonbill (Ajaia ajaia), have reduced their naris to a slit or eliminated it entirely. Most other birds had a large naris separated from the antorbital fenestra. Others, such as the cassowary (Casuarius casuarius) had a large confluent naris and antorbital fenestra. These bird skulls can be seen here.

Did Pterosaurs Breathe Through Their Nostrils?If they had big nostrils, yes. Tiny nostrils, hmm, probably not. Along with a reduction in naris size and elongation of the jaws there is a general trend toward filling in the palate. That may have been more of structural innovation than a way to separate air from water and food, considering the reduced size of the naris in these pterosaurs.

SummaryRather than confluence, the naris in derived pterosaurs was reduced five separate times by convergence. The narial reduction occurred during phylogenetic size reductions and was retained by their larger descendants.

Nasalis is a paired muscle that covers the dorsum of the nose. It consists of two parts; alar and transverse. The alar part is also called dilator naris posterior, and the transverse part is known also as the compressor naris. Together with procerus, levator labii superioris alaeque nasi and depressor septi muscles, nasalis belongs to the nasal group of facial muscles.

Nasalis muscles are found on each side of the midline, respectively. Each muscle is composed of two parts; lateral or transverse part (compressor naris) and medial or alar part (dilator naris posterior).

The alar part comprises the nostrils. It originates from the frontal process of maxilla, just superior to the lateral incisor. After a short superoanterior course, it inserts to the skin of ala, superior to the lateral crus of major alar cartilage. Here, some fibers blend with the transverse part of nasalis.

A small muscle called dilator nasi anterior, or apicis nasi, attaches to the anterior margin of the alar part of nasalis muscle. Several arteries and nerves course over the superior surface of nasalis including, the facial artery, terminal branches of the infraorbital artery and nerve, and the external nasal artery and nerve.

The transverse part of nasalis wrinkles the nasal skin and compresses the nasal aperture, hence its other name compressor naris. The alar part dilates the nostrils as it pulls the ala laterally, thus its name dilator naris posterior.

Physical examination revealed severe closed rhinolalia and no airflow in both of his anterior naris. Three nostrils were identified on his external naris. His left naris, round-shaped and about 1 cm in diameter, was normal. However, his right anterior naris was divided into two parts by a barrier diaphragm which protruded from the lateral wall (Figure 1). The medial part of his right naris was relatively large, similar to the left, and connected to the nasal cavity, while the lateral part was approximately 0.3 cm in diameter and did not communicate with the nasal cavity.

During the surgery, we found his right anterior naris was divided into two parts by a barrier diaphragm. The lateral part of the right anterior naris was a caecum and did not open to the nasal cavity. After the diaphragm was removed, the right anterior naris was recovered (Figure 6).

A soft and elastic membrane was found to block both posterior nares. A cruciate incision was made in the membrane center and the openings were widened to the bony part of the posterior nares. A silica gel about 0.8 cm in diameter and 7 cm in length, with multiple holes in the lateral wall, was placed bilaterally from anterior to posterior nares to prevent re-stenosis. The silica gel was removed six weeks later. After more than three years of follow-up, both anterior and posterior nares were capacious and nasal ventilation was normal (Figures 9 and 10). Olfactory function recovered partially. Closed rhinolalia and sleep snoring were all remarkably relieved. 041b061a72


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