The Frontal View of the Nose: Lighting Effects and Photographic Bias.

BACKGROUND: Most aesthetic rhinosurgeons rely on proper photographic documentation of the nose using several different views. The frontal view is probably the most important, but it is also the most demanding. OBJECTIVES: In the frontal view, delicate, 3-dimensional (3D) anatomic structures require special photographic skills. Lighting is crucial for detail rendition and 3D reproduction of the nose, and for apparent photographic bias. METHODS: We compared the quality of reproduction and photographic bias with different symmetric and asymmetric lighting in common clinical practice described in the literature. The photographs were compared for anatomic reproduction, shadowing, 3-dimensionality, and apparent changes of nasal shape (bias). RESULTS: Symmetric lighting did not satisfy the demands of the rhinosurgeons because of marginal 3-dimensionality, reduced detail rendition, or photographic bias. Strongly asymmetric lighting altered the nasal shape adversely for bias depending on the side of illumination, but led to very good 3-dimensionality. Slightly asymmetric lighting demonstrated the best results for detail rendition and 3-dimensionality. CONCLUSIONS: Classic symmetric quarter light is a practicable lighting technique with limitations in the rendition of detail and 3-dimensionality. Slightly asymmetric lighting offered a perfect compromise, with substantially improved detail rendition and 3-dimensionality. Strongly asymmetric lighting may lead to photographic bias depending on the side of illumination. Frontal documentation of the nose with asymmetric lighting should, therefore, always be performed in duplicate, with asymmetric lighting from the right side and from the left side, to prevent misleading interpretations.

Evaluation of the intranasal flow field through computational fluid dynamics.

A reliable and comprehensive assessment of nasal breathing is problematic and still a common issue in rhinosurgery. Impairments of nasal breathing need an objective approach. In this regard, currently rhinomanometry is the only standard diagnostic tool available but has various limitations. However, in the last decade, computational fluid dynamics (CFD) has become a promising method in facing the challenge of qualifying nasal breathing. This article presents use of CFD with a symptom-free subject and a symptomatic patient. Thereby, certain flow field features and changes before and after surgery were investigated. Moreover, the study outlines suggestions for concrete rhinologic CFD applications.