Han Seung-Kyu, Lee Dong-Geun, Kim Jung-Bae, Kim Woo-Kyung
Department of Plastic and Reconstructive Surgery, College of Medicine and Medical Science Research Center, Korea University, Seoul, Korea.
Ann Plast Surg. 2004 Feb;52(2):134-9. doi: 10.1097/01.sap.0000095439.98488.e6.
Successful rhinoplasty depends on nasal tip support and its influence on nasal tip projection. It is generally agreed that the components of nasal tip support include the attachment between the upper and lower lateral cartilages, the attachment between the lateral crus of the lower lateral cartilage and the pyriform aperture, the attachment between the paired domes of the lower lateral cartilages, and the medial crural attachment to the caudal septum. However, these structures are still not clearly determined, and there was no anatomic study of nasal tip supporting structures in Asia. The purpose of this study was to determine the nasal tip supporting structures and find out the differences in these structures between white and Asian people. Ten noses of fresh cadavers were investigated. Dissection was performed and the previously mentioned nasal tip supporting structures were observed and excised. Histologic examination was done with hematoxylin and eosin stain and Van Gieson elastin stain. Macroscopic study showed that there were dense fibrous tissue between the upper and lower lateral cartilages, dense fibrous tissue and sesamoid cartilages between the lateral crus and the pyriform aperture, loose connective tissue between the paired domes of lower lateral cartilages, and no identified specific tissue between the medial crus and the caudal septum. Microscopic investigation allowed a more detailed analysis of these structures. Between the upper and lower lateral cartilages, dense collagen fibers were running in one direction and anchoring firmly to each cartilage, which meets the histologic criteria of a ligament. Between the lateral crus and the pyriform aperture, there were intermingled collagen fibers and muscular fibers, which meets the histologic criteria of fibromuscular tissue. Between the paired domes of lower lateral cartilages, there were few fibers with abundant amorphous ground substances, which meets the histologic criteria of loose connective tissue. Based on our results, we recommend that the previously mentioned nasal tip supporting structures should be named intercartilaginous ligament, sesamoid fibromuscular tissue, and interdomal loose connective tissue, respectively. In addition, we consider that the loose connection between the domes of middle crura and the absence of an attachment of the medial crura to the caudal septum can be one of the reasons why the nasal tip of Asian people is broad and unprojected and the base is wide.
成功的鼻整形术取决于鼻尖支撑及其对鼻尖突出度的影响。人们普遍认为，鼻尖支撑的组成部分包括上外侧软骨与下外侧软骨之间的附着、下外侧软骨外侧脚与梨状孔之间的附着、下外侧软骨双侧穹隆之间的附着以及内侧脚与鼻中隔尾端的附着。然而，这些结构仍未明确界定，亚洲地区也没有关于鼻尖支撑结构的解剖学研究。本研究的目的是确定鼻尖支撑结构，并找出白种人和亚洲人在这些结构上的差异。对10具新鲜尸体的鼻部进行了研究。进行了解剖，并观察和切除了上述鼻尖支撑结构。采用苏木精-伊红染色和范吉森弹性蛋白染色进行组织学检查。宏观研究表明，上外侧软骨与下外侧软骨之间存在致密纤维组织，外侧脚与梨状孔之间存在致密纤维组织和籽状软骨，下外侧软骨双侧穹隆之间存在疏松结缔组织，内侧脚与鼻中隔尾端之间未发现特定组织。显微镜检查对这些结构进行了更详细的分析。在上外侧软骨与下外侧软骨之间，致密的胶原纤维呈单向排列并牢固地附着于每个软骨，符合韧带的组织学标准。在外侧脚与梨状孔之间，胶原纤维和肌纤维相互交织，符合纤维肌肉组织的组织学标准。在双侧下外侧软骨穹隆之间，纤维较少，有丰富的无定形基质，符合疏松结缔组织的组织学标准。根据我们的研究结果，我们建议将上述鼻尖支撑结构分别命名为软骨间韧带、籽状纤维肌肉组织和穹隆间疏松结缔组织。此外，我们认为中脚穹隆之间的松散连接以及内侧脚与鼻中隔尾端无附着可能是亚洲人鼻尖宽且不突出、鼻基底宽的原因之一。
