What are the anatomical structures of the medial and lateral walls of the nose, including blood supply, in a patient with a history of ear or balance problems, such as Meniere's disease?

Anatomy of the Medial and Lateral Nasal Walls with Blood Supply

Structural Framework

The nasal cavity is divided into medial and lateral walls, with the medial wall formed entirely by the nasal septum and the lateral wall comprising the turbinates and their attachments. 1

Medial Wall (Nasal Septum)

The medial wall consists of the nasal septum, which is composed of both cartilaginous and bony components:

Cartilaginous Components:

• Septal cartilage forms the anterior-inferior portion and is the primary structural element providing stiffness to the external nose 1
• The septal cartilage is hyaline cartilage with high density of type II collagen (90-95%), particularly in peripheral zones, which provides structural rigidity 1
• The cartilage has characteristic cellular organization: peripheral zones contain numerous small flat chondrocytes oriented parallel to the surface, while central zones have larger ovaloid cells oriented perpendicular to the surface 1

Bony Components:

• The perpendicular plate of the ethmoid bone forms the superior-posterior portion 1
• The vomer forms the inferior-posterior portion 1
• These structures attach to the maxillary crest and nasal spine inferiorly 1

Critical Anatomical Note: The septum lacks vascular and nerve supply within the cartilage itself, resulting in no healing capacity—a major consideration for surgical planning 1

Lateral Wall

The lateral wall is more complex and contains multiple structures:

Turbinates (Conchae):

• Inferior turbinate attaches to the lateral nasal wall at the piriform aperture level 1
• Middle turbinate serves as the medial boundary of the "paranasal surgical box" 2
• Superior turbinate (when present) 2

Bony Framework:

• The nasal bones form the upper third of the lateral wall 1
• The maxillary bone contributes to the middle and lower portions 1
• The lateral nasal wall connects to the piriform aperture anteriorly 1

Cartilaginous Elements:

• Upper lateral cartilages (triangular cartilages) conjoin with the dorsal septum in the middle third 1
• Lower lateral cartilages (alar cartilages) form the lower third and nasal tip 1
• Small sesamoid and accessory cartilages exist in intercartilaginous joint areas 1

Anatomical Divisions for Clinical Assessment

The nose should be conceptualized in horizontal thirds for systematic analysis: 1

• Upper third: Bony pyramid (nasal bones) 1
• Middle third: Dorsal septum and conjoined upper lateral cartilages 1
• Lower third: Alar cartilages, caudal septum, and alar base 1

This division is clinically important because surgical treatment differs for each third 1

Blood Supply

While the provided evidence does not contain detailed vascular anatomy, the following principles apply based on the structural descriptions:

Key Vascular Considerations:

• Cartilage is avascular: The septal and lateral nasal cartilages lack direct blood supply, receiving nutrition only through diffusion from the perichondrium 1
• Mucosal blood supply is critical for maintaining the overlying mucoperichondrium and mucoperiosteum 1
• Periosteal and perichondrial attachments must be preserved during surgery to maintain blood supply to bony and cartilaginous structures 1

Surgical Implications:

• Preservation of periosteal and mucosal attachments during osteotomies minimizes destabilization of the osseous framework 1
• Periosteal tunnels are detrimental to support and should be avoided 1
• The suspensory ligaments of the lower lateral cartilages receive vascular support from a spicule of bone at the piriform aperture that should be preserved 1

Clinical Relevance to Meniere's Disease Context

Important caveat: The anatomical relationship between nasal structures and inner ear pathology (such as Meniere's disease) is indirect. Meniere's disease is a disorder of the inner ear characterized by endolymphatic hydrops affecting the cochlea and vestibule 3, 4, 5. The nasal anatomy described above has no direct anatomical or vascular connection to the pathophysiology of Meniere's disease, which involves endolymphatic absorptive dysfunction in the endolymphatic duct and sac 4, 5.

Anatomical Variants

Common variations include: 6, 2

• Septal deviations (most commonly from trauma) 7
• Turbinate hypertrophy or anatomic variants 6, 2
• Cartilaginous overgrowth on the dominant side after septal deviation, which progressively worsens over time 7