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Anatomical and histological study of the arterial distribution in the columellar

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Surg Radiol Anat (2014) 36:669–674
DOI 10.1007/s00276-013-1253-7
Original Article
Anatomical and histological study of the arterial distribution
in the columellar area, and the clinical implications
Young‑Il Lee · Hun‑Mu Yang · Hee‑Jang Pyeon ·
Hong‑Ki Lee · Hee‑Jin Kim
Received: 28 August 2013 / Accepted: 27 December 2013 / Published online: 10 January 2014
© Springer-Verlag France 2014
Abstract
Purpose The aim of this study was to elucidate the distri-
bution of the columellar artery (CoA) in the mobile nasal
septum by means of detailed dissection and histological
observation.
Methods Fifteen Korean cadavers were examined; five
specimens were dissected to observe the ramification pat-
tern of the CoA from the superior labial artery (SLA), and
the noses of ten specimens were quick-frozen in isopro-
panol cooled with liquid nitrogen and then cryosectioned at
a thickness of 40 μm.
Results The arterial vasculature of the CoA in the colu-
mella was supplied by the SLA and entered the columella
via the columellolabial junction. The vessels of the CoA
proceeded anteriorly, inferior to the medial crus of the
lower lateral cartilage (MC) at the midline, at the basal
and posterior portions of the septum. The vessels traveled
closer to the MC than the epidermis. There were very few
vessels in the area between the left and right MCs, which
was usually packed only with loose connective tissue. More
Y.-I. Lee · H.-M. Yang
Department of Anatomy, College of Medicine,
Dankook University, Cheonan, Korea
H.-J. Pyeon
Department of NanoBio Medical Science, Dankook University,
Cheonan, Korea
H.-K. Lee
Image Plastic and Aesthetic Surgery Clinic, Seoul, Korea
H.-J. Kim (*)
Division in Anatomy and Developmental Biology,
Department of Oral Biology, Yonsei University College
of Dentistry, Seoul, Korea
e-mail: hjk776@yuhs.ac
anteriorly, there were more abundant vessels between the
MC and the epidermis, with a dispersed distribution. In
axial sections, multiple vessels were dispersed in front of
the MC, with the pattern varying among the specimens.
Furthermore, tiny vessels were also detected in the vicinity
of the septal cartilage posterior to the MC. The microdistri-
bution near to the MC was almost consistent.
Conclusion The anatomical findings of the CoA in this
study will be useful for safe manipulations during various
medical interventions in the columella.
Keywords Columellar artery · Mobile septum · Dermal
filler injection · Histological study · Rhinoplasty
Introduction
Asian noses are characterized morphologically by a short
columella, an acute nasolabial angle (columellolabial
angle), inadequate tip projection, and weak underlying car-
tilaginous segments [6]. Rhinoplasty to increase the nasola-
bial angle and elevate a tip of the nose is one of the most
popular esthetic interventions in Asia today [7]. To that
end, autografted tissue or artificial material is implanted to
augment the underdeveloped medial crus of lower lateral
cartilage of the nose (MC).
Padovan and Jugo [11] noted that the columellar artery
(CoA) ascends vertically from the superior labial area and
is distributed within the columella and the membranous sep-
tum, and that transcolumellar incision unavoidably results
in scission of the CoA. Previous anatomical studies have
shown that the lateral nasal artery (LNA) is the main sup-
plying artery of the nose tip, and that the dorsal nasal artery
(DNA) and CoA are supplementary arteries that anastomose
with the LNA [5, 10]. It was thus proposed that there is only
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670
a low risk of necrosis of the nose tip following impinge-
ment of the CoA during surgical external rhinoplasty [15].
Nevertheless, excessive bleeding of the columella following
inevitable amputation would cause accumulation of blood,
causing an esthetic complication [4].
The injection of dermal filler targeting the base of the
columella and the membranous septum is being performed
increasingly frequently to accomplish the same goal as an
operative rhinoplasty to improve the nasolabial angle. This
so-called filler rhinoplasty is a simple and noninvasive
technique in which the physician uses a needle or a cannula
without an incision. Thus, in contrast with surgical exter-
nal rhinoplasty, filler rhinoplasty can avoid vascular com-
plications, with meticulous care of the arterial distribution
in the columella [2]. However, filler rhinoplasty is a blind
technique in which the vascular distribution is not identi-
fied anatomically. Therefore, it is important to know the
detailed configuration of the CoA in the columellar area in
order to prevent vascular mutilation during the filler rhino-
plasty technique.
While the origins, ramifying patterns, and distribution
layer have already been reported, the exact course in refer-
ence to the adjacent structures such as the MC, and major
distribution areas within the columella have not been eluci-
dated [5, 8, 10, 11]. The purpose of the present study was
to clarify the arterial distribution of the CoA in the colu-
mella and the membranous septum of the Korean nose by
means of gross and histological observations of specimens
from human Korean cadavers.
Materials and methods
Fifteen Korean cadavers (ten males, five females; mean age
63.9 years old) were examined in the present study. Ten
cadavers were fixed and resting five cadavers were not fixed.
In five fresh cadavers, the skin on the whole face including
the nose was stripped off to enable gross observations of the
distribution of the facial artery (FA), while in the ten fixed
cadavers the skin on the perioral area except the nose was
stripped off and the arterial vasculature from the FA was
observed. The superficial and deep septal branches from the
FA were examined and the orbicularis oris muscle (OOr)
was dissected to allow observation of the detailed distribu-
tion of the septal branches. The noses of these ten cadav-
ers, including the nasal septum, the tip, and the columella,
were removed and then subjected to a cryoprotection pro-
tocol (to prevent ice-crystal damage) by soaking them first
in 10 % and then 20 % (weight/volume) sucrose solutions
in phosphate-buffered saline at 4 °C for 30 min. They were
then transferred to a 30 % sucrose solution and soaked over-
night at 4 °C. At each stage of the sucrose series (i.e., 10,
20, and 30 %) the tissues were not transferred to the next
13
Surg Radiol Anat (2014) 36:669–674
most concentrated solution until they had sunk to the bot-
tom of the sucrose solution that they were in.
The sucrose-infiltrated tissues were immersed in OCT
embedding medium (Tissue-Tek, Torrance, CA, USA) and
then quick-frozen in isopropanol cooled by liquid nitrogen
for about 30 s. Each frozen tissue block was cryosectioned
at a thickness of 40 μm in the coronal (seven specimens)
or axial (three specimens) plane using a cryostat (Leica
CM1850, Leica, Wetzlar, Germany). The sections were col-
lected and mounted onto gelatin double-coated slides. The
tissue sections were stored in a deep freeze at −70 °C until
required for staining.
The detailed distribution of the blood vessels in the tis-
sue sections was revealed by staining them with hematoxy-
lin and eosin (Sigma Aldrich, Poland). The tissue sections
were stained using the following procedure: (1) staining
with hematoxylin for 3 min, (2) washing with tap water,
(3) destaining in 1 % acid ethanol, (4) further washing with
tap water, (5) counterstaining with eosin for 30 s, (6) dehy-
dration in an ascending series of ethanol concentrations up
to 100 % until the liquid was transparent, (7) immersion
in xylene three times for 30 min, and (8) mounting with
Poly-Mount xylene (Polysciences). After being allowed to
dry inside a fume hood, the sections were observed under a
light microscope (Olympus BX-51, Olympus, Japan).
Results
Gross observations of the superior labial artery and CoA
The superior labial artery (SLA) gave off the superficial
and deep septal branches that ascended in the philtrum
toward the nasal septum in all cases (Fig. 1). The deep sep-
tal branch was covered by the OOr and ascended within the
muscle. The superficial septal branch proceeded upward on
the OOr and continued as the CoA after the columellola-
bial junction. Gross observations revealed that the CoA
proceeded anteriorly in the columella toward the tip of the
nose (Fig. 1b). Since the mobile nasal septum specimen
was removed from the cadavers only after confirming the
supplying branch of the superficial septal branch to the
specimen, the arterial vasculature on the specimen can be
regarded as being supplied by the superficial septal branch.
In addition, it was observed that the CoA in the tip of the
nose formed the arterial plexus with the arterial vessels
from the dorsum or alae of the nose.
Histological observation of the mobile nasal septum
specimen on coronal sections
The histological observations were typical. At the basal
portion, the arterial vasculature of the CoA was located
Surg Radiol Anat (2014) 36:669–674
Fig. 1  Columellar artery from the superior labial artery on the gross observation. a Specimen of fixed cadaver before removal of the mobile sep-
tum, b specimen of fresh cadaver after stripping off the skin of the columella. Arrowhead superior labial artery, arrow columellar artery
between the MC and epidermis (Fig. 2a). In contrast,
there was no CoA vasculature between the right and left
MCs.
At the posterior half of the septum, two or three distinct
vessels were observed inferior to the MC and within the
midline portion (Fig. 2b). The arterial vessels of the CoA
were closer to the MC than to the epidermis. Mostly, the
distances between the skin surface and the vessels ranged
from about 1.5 to 2.5 mm. The area between the right and
left MCs was packed with loose connective tissue and the
arterial vasculature.
At the anterior half of the septum, the vascular distri-
bution was distributed between the MC and the epidermis
(Fig. 2c), and appeared to be more widely dispersed at
the anterior portion of the septum near the tip of the nose
(Fig. 2d). The arterial vessels were positioned more evenly
between the MC and the epidermis, in contrast to the ves-
sels of the posterior portion of the septum, where they were
mostly closer to the MC than to the epidermis. Some ves-
sels were located within 1 mm from the skin surface.
Histological observation of the mobile nasal septum
specimen on axial sections
At the level of the columellolabial junction, the distinct
arteries were observed between the epidermis and the sep-
tal cartilage (SC, Fig. 3a). At the level of the tip of the nose,
the arterial vasculature was observed near the MC (Fig. 3b).
While the branch proceeding anteriorly along the MC and
toward the tip of the nose was found on gross observations,
small arterioles from the superficial septal branch to the SC
were also recognized on microscopic observation (Fig. 3c).
671
The arterial vasculature on this section was concentrated
near to the MC. More distinct and larger arteries and arte-
rioles were observed at the midline in front of the MC.
There were very few arterioles between the right and left
MCs. The morphological pattern of the arterial vascula-
ture in these sections varied in shape, being round, oval, or
obliquely sectioned (Fig. 3b). The abundant vascularization
and the wide variety patterns between sections support the
gross observation of an arterial plexus near to the tip of the
nose.
Discussion
The CoA is the continuation of the SLA, and supplies the
columella and the membranous septum including the tip of
the nose [14]. Park et al. [12] reported that the SLA gave
off superficial and deep ascending branches in the philtrum,
and that the superficial branch proceeded toward the nostril
sill and nasal septum. Nakajima et al. [10] also mentioned
that the superficial branch in the philtrum ascended further
and was distributed within the columellar area. They also
reported that the branches entering the columellar area con-
stituted the arterial plexus in the tip of the nose.
Jung et al. [5] reported that the CoA in Korean human
cadavers was ramified from the SLA unilaterally in 51 %
of cases. Pinar et al. [14] reported that the branching pat-
tern of the CoA could be classified into single straight
(48.9 %), two straight (38.7 %), and forked (12.2 %) types.
In the present study, the microdistribution of the CoA on
the mobile nasal septum was typical, regardless of arterial
asymmetry. The arterial distributions of the CoA were not
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672
Fig. 2  Arterial vasculatures of the columella artery (CoA) on the
columella and membranous septum in coronal section. a The basal
plane near the columellolabial junction, b the posterior one-third
plane between the basal plane and the nose tip, c the anterior one-
exactly symmetrical in every cases (Figs. 2, 3). Neverthe-
less, the vessels at the base of columella were located near
the MC, similar to the symmetrical cases. There was a ten-
dency for the arterial vasculature to be dispersed more in
the anterior area of the columella.
Gross observations in the present study revealed that all
of the CoA was ramified from the SLA, and thus the colu-
mella and the membranous septum of the nose were found
to be supplied by septal branches from the SLA. In the
axial sections of the present study, the arterial vasculature
was mostly located between the MC and the epidermis;
however, some arterioles ascended between the SC and MC
13
Surg Radiol Anat (2014) 36:669–674
third plane between the basal plane and the nose tip, d the plane
about 2 mm posterior to the nose tip. MC medial crus of lower lateral
cartilage, SC septal cartilage; arrowhead arterial vessel of the CoA
(Fig. 3c). From the histological point of view, the vessels of
the CoA entered the basal portion of the columella via the
columellolabial junction and proceeded anteriorly to the tip
of the nose via small branches. However, it is not possible
to state categorically that the CoA is the sole arterial supply
to the tip of the nose.
At the anterior half of the septum, the vessels seemed
to form anastomoses with other vessels from the arterial
vasculature, since there were multiple areas of arterial vas-
culature of various shapes and sizes throughout the sec-
tions. The histological findings of an arterial plexus on the
anterior portion of the nose support the results of the gross
Surg Radiol Anat (2014) 36:669–674
Fig. 3  Arterial vasculatures of
the columella artery (CoA) on
the columella and membranous
septum in axial section. a The
basal plane on the columellola-
bial junction, b the plane
passing through the nose tip,
c the plane about 0.5 mm
superior to the level of the nose
tip. MC medial crus of lower
lateral cartilage, SC septal carti-
lage; arrowhead arterial vessel
of the CoA, arrow depressor
septi nasi muscle fiber
observation in this study and previous findings of multiple
blood supplies to the tip of the nose. Many authors have
suggested that scission of the CoA would not cause necro-
sis of the nose tip, based on the presence of this nose-tip
arterial plexus formed by the LNA and DNA [3–5, 9, 11,
15, 16]. However, the vascular insufficiency with direct
intravascular injury or indirect external compression on the
arterial plexus would make esthetic problem such as mak-
ing a purple discoloration, partial or total skin necrosis. A
mucous cyst may also form, thus degenerating the shapes
of the columella and philtrum. Redness, swelling, and
ecchymoses would result from a vascular accident involv-
ing the CoA, in the condition of vascular insufficiency of
arterial plexus injury, which is likely to distress the patient
temporarily or permanent deformity of the nose can be
made with disfigurement. Especially the patients with pre-
vious transcolumellar open rhinoplasty might have scission
of CoA. In those cases the filler injection at the nasolabial
crease and alar depression area might result in vascular
compromise to the nasal alae and the tip due to interrup-
tion of arterial plexus. The patients with repeated filler
673
injection histories might be one of the high-risk candidates,
in which scar tissue formed at the plane of filler injections,
which might result in vascular compromise with even slight
external compression to the CoA with final filler injection
[13]. In the present study, the distinct vessels from the CoA
proceeded anteriorly within the columella area from the
columellolabial junction to the tip. In addition, the space
between the right and left MCs was packed with loose con-
nective tissue, with almost no distinct vessels.
Daniel and Letourneau [1] reported that the external lay-
ers of the nose comprised a superficial fatty layer, a fibro-
muscular layer, a deep fatty layer, and the periosteum. They
also noted that the major blood vessels were located in the
deep fatty layer under the fibromuscular layer. Toriumi et al.
[17] mentioned that the arterial vessel coursed in or under
the musculoaponeurotic layer. The musculoaponeurotic
layer in their study is identical to the fibromuscular layer in
the study of Letourneau and Daniel, [8] and this layer was
shown to be a part of the superficial muscular aponeurotic
system (SMAS). The sub-SMAS space between the fibro-
muscular layer and periosteum is recommended as an ideal
13
674
injection plane for fillers, since placement of a filler mate-
rial within the supra-SMAS (superficial fatty layer) would
be visible and palpable and within the deep fatty layer raise
the chance of the vascular compromise due to location of
the vessels. Thus, in the case of the recommended manipu-
lation at the base of the columella, the placement of filler
material within the deep fatty layer would affect the blood
circulation of the CoA via direct injury or indirect external
compression. The findings of the present study demonstrate
that the vessels of the CoA are located closer to the MC
than the epidermis within deep fatty layer at the basal and
posterior portions of the columella and the membranous
septum of the nose. Near the tip of the nose, the vessels
seemed to be dispersed within the superficial and deep fatty
layers between the MC and the epidermis.
In conclusion, the information of the exact distribution
of the CoA in the columella and the membranous septum is
important for certain protocols, such as dermal filler injec-
tion into the columella to improve the nasolabial angle at
the columellolabial junction. The anatomy of the CoA as
found in the present study supports previous anatomical
reports of the CoA running posterioanteriorly within the
columella, supplying adjacent tissue. However, the histo-
logical observations in present study have provided more
details of the arterial distribution, from deep to superficial
along with base to tip. The anatomical findings of the CoA
in this study will be useful for ensuring the safe manipula-
tion of dermal filler injections and surgical intervention of
the columella.
Acknowledgements This work was supported by the National
Research Foundation of Korea (NRF) grant funded by the Korea gov-
ernment (MEST) (No. 2011-0007612). We thank Sang-hoon Kwon at
New York University College of Arts and Science and So-yeon Kim
at Georgetown University College of Arts and Science for assisting in
revising manuscript and anatomical procedure.
Conflict of interest All authors have no financial and private rela-
tionships with commercial and political organization or people that
could improperly influence this research.
13
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Surg Radiol Anat (2014) 36:669–674
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