Ethnic Rhinoplasty in Tunisia

The bellow anatomic differences, even within the African American population, emphasize the importance of an individualized approach to an ethnic rhinoplasty using sound principles.

Considering the structural components of the nose, differences have been noted in the skeletal and cartilaginous framework of the nose in patients of African American descent when compared with that of other ethnic groups.

A study of the nasal bones and pyriform apertures of cadaver skulls with anthropometric measurements reported by Ofodile in 1994 again showed evidence of the triethnic heritage of the African American patient. Skulls from the West African Ashanti tribe studied had nasal bones that were short, narrow, and thick when compared with American Indian and Caucasian skulls. Similar measurements in the African American skulls were found to fall between the West African and Caucasian/Indian American groups. The shape of the pyriform aperture in the African American skulls varied from oval to triangular, again falling between the Ashanti and Caucasian/Indian American groups, which had apertures that were oval and triangular In addition to these findings, as has been reported by others, the nasal bones in the skulls of African origin had an obtuse angular relationship to each other at the nasal dorsum. The clinical significance of these findings is that attempts to improve dorsal apex projection are better achieved by dorsal augmentation as opposed to osteotomy and infracture.

Alar cartilage in African American patients, extrapolated from cadaver studies, also appears to show some variation along the previously mentioned triethnic lines; variations were primarily seen in the range of anteroposterior alar cartilage width. Cadavers with the African type nose had narrower alar cartilage compared with the Afro-Indian and Afro-Caucasian type noses. Any form of cephalic alar excision in these patients with narrow alar cartilage should be approached with caution given the risk for alar collapse. On average, though, the height and width of the lower lateral crura in African American patients were found to be similar to dimensions found in Caucasian patients. The distance from the lower margin of the alar cartilage to the nostril rim was also found to be similar in both African American and Caucasian patients. Differences between African American and Caucasian patients at the level of the alar cartilage can be attributed to the angle of inclination of the alar cartilage relative to the plane of the maxilla. Morphologically, in African American patients with a more acute cartilage angle of inclination, the nasal base appears widened and the nose has less tip projection. Flaring of the alae and the bulbous tip in addition contribute to a distinctly different appearing nose when compared with the Caucasian nose.

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