What is the columella?

The Columella: Anatomical and Clinical Significance

The columella is the narrow bridge of tissue that separates the nostrils and connects the nasal tip to the nasal base and upper lip. It is a critical anatomical structure that contributes significantly to both the functional and aesthetic aspects of the nose 1.

Anatomical Components

The columella consists of several key anatomical components:

1. Cartilaginous framework:

   • Medial crura of the lower lateral cartilages
   • Caudal portion of the nasal septum

2. Soft tissue elements:

   • Columellar skin
   • Membranous septum
   • Subcutaneous tissue
   • Depressor septi nasi muscle attachments

3. Bony support:

   • Anterior nasal spine (which influences columellar position)

Clinical Significance

Aesthetic Importance

The columella plays a crucial role in nasal aesthetics by:

• Defining the nasolabial angle (ideally 90-100 degrees)
• Contributing to nasal tip projection
• Creating proper nostril shape and symmetry
• Establishing balance between the nasal base and tip

Abnormalities in columellar position can result in:

• Hanging columella: When the columella extends too far below the alar rims, creating an undesirable appearance 2, 3
• Short columella: Insufficient columellar show, often associated with decreased tip projection 4

Surgical Considerations

The columella is a critical structure in rhinoplasty procedures:

• It serves as the access point for open rhinoplasty via a transcolumellar incision
• It may require specific correction in cases of deformity
• It can be used for camouflaging techniques in deviated noses 1

In surgical approaches:

• External rhinoplasty approaches often leave a scar on the columella, which is generally well-concealed 1
• Columellar refinement may involve addressing any of the six components: caudal septum, medial crura, columellar skin, membranous septum, anterior nasal spine, and depressor septi nasi muscle 3

Reconstruction Considerations

When columellar reconstruction is necessary:

• Composite grafts (containing skin and cartilage) are often required to provide both structural support and skin coverage 5, 6
• Donor sites may include the auricular helix or conchal cartilage with overlying skin 5, 6
• VY advancement flaps can be used to address short columella in aesthetic rhinoplasty 4

Pathological Considerations

The columella may be affected by:

• Congenital deformities (particularly in cleft lip and palate)
• Traumatic injuries
• Iatrogenic causes (previous surgical complications)
• Inflammatory conditions
• Neoplastic processes

Clinical Assessment

When evaluating the columella, clinicians should assess:

• The columella-labial angle
• The ratio of columellar show to nostril height
• The relationship between the columella and alar rims
• The width and symmetry of the columella
• The quality and quantity of skin coverage

Management of Columellar Abnormalities

Management depends on the specific abnormality:

• Hanging columella: May require resection of redundant caudal septum, trimming of medial crura, or excision of excess columellar skin 2, 3
• Short columella: May require tissue augmentation through composite grafting, VY advancement flaps, or other tissue rearrangement techniques 4, 6
• Deviated columella: May require septal correction, medial crura repositioning, or camouflage techniques 1

The goal of any intervention is to achieve a balanced, natural-appearing nose with proper functional and aesthetic relationships between all nasal components.