The dorsal nasal artery is a terminal branch of the ophthalmic artery that exits the orbit at the medial orbital rim above the medial canthal tendon to supply the skin of the nasal dorsum and the tip of the nose. It anastomoses at the nasal tip with the angular artery (terminal facial artery), creating the critical ICA-ECA anastomosis at the nasal bridge. This anastomosis is used clinically to assess ophthalmic artery patency in carotid disease.
The dorsal nasal artery anastomosis with the angular artery at the nasal tip is the anatomical basis of the ocular pneumoplethysmography (OPG) test for ICA occlusion: the angular artery pulsations at the medial canthus reflect retrograde filling through the nasal tip anastomosis when the ICA is occluded. In rhinoplasty, the dorsal nasal artery is at risk during open rhinoplasty dissection of the nasal dorsum; its injury contributes to nasal tip ischaemia. The artery is harvested in forehead flap elevation as it contributes to the supratrochlear angiosome.
Aggressive subcutaneous dissection of the nasal dorsum and tip in open rhinoplasty disrupts the dorsal nasal artery and its anastomoses, producing nasal tip blanching, prolonged capillary refill, and risk of necrosis; recognising the angiosome boundaries of the supratrochlear and dorsal nasal arteries guides safe dissection planes.
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