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8.04: Zone N2 – Rhinion

YOUR ASSIGNMENT FOR THIS LESSON

✅ Step #1: Review all content below.

✅ Step #2: Image the N2 zone on your own with your ultrasond, and using the checklist provided on this page, check off all key structures to be identified in this location

TRANSDUCER POSITION AT N2

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STANDARD N2 ORIENTATION:
TRANSVERSE & LONGITUDINAL

The rhinion, the junction between the nasal bone and cartilage, to the nasal tip at N3, is the location of N2.

QUICK TIP
  • You need A LOT of gel in this location due to the contour of the nose not allowing for the full probe to be flush with the skin. Fill any areas that cannot be in contact with the probe with gel to optimize your images.
  • N2 involves scanning through the midline and slightly off midline, from the rhinion to the nasal tip. Move slowly for you can appreciate the anatomy in this location both in longitudinal and transverse.
  • You will visualize both the nasal bone and cartilage here. Often, cartilage will appear bone-like and slightly less hyperechoic than bone.

EXAMPLE OF TRANSVERSE IMAGE ACQUIRED AT N2

Standard image acquired at N2 on midline. (Transverse| Left side is patient's right). See key below for lables.*

ANATOMICAL LEGEND FOR N2 LOCATION IN TRANSVERSE

*Standard image acquired at N2 labeled with key anatomical structures.

EXAMPLE OF LONGITUDINAL IMAGE ACQUIRED AT N2 AT MIDLINE

Standard image acquired at N2 midline. (Longitudinal | Left side is deep). See key below for lables.*

ANATOMICAL LEGEND FOR N2 AT MIDLINE IN LONGITUDINAL

*Standard image acquired at N2 at midline, labeled with key anatomical structures.

EXAMPLE OF LONGITUDINAL IMAGE ACQUIRED AT N2 LATERAL TO MIDLINE

Standard image acquired at N2, 1cm lateral from midline. (Longitudinal | Left side is deep). See key below for lables.*

ANATOMICAL LEGEND FOR N2 AT LATERAL TO MIDLINE IN LONGITUDINAL

*Standard image acquired at N2, 1 cm lateral to midline, labeled with key anatomical structures.

DOPPLER IMAGES ACQUIRED AT N2 OF KEY VESSELS

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QUICK TIP
  • N2's vessels are often small with slower flow. Power doppler can be useful here, also if using color doppler turn your sensitivity to 2cm/s to detect the slower flow. Just be mindful of motion artifacts.
  • You need to keep pressure off the nose; otherwise, you will easily occlude these vessels. Again, use lots of gel and a very light touch. Pressure should be applied to the gel, not directly to the skin.
  • The dorsal nasal arteries are often just off the midline, gliding a few mm lateral from the midline will help to detect these vessels. Be aware that if you move too lateral you will encounter the angular artery.
    • Recall the direction of the dorsal nasal vessels and the lateral nasal vessels and the orientation of your probe (transverse versus longitudinal, and how you would expect the vessels to appear in this regards.

DO IT YOURSELF CHECKLIST

Structures to Identify on Ultrasound for N2

Once you have completed this checklist, mark this part of the lesson as complete.