Rohrich Rod J, Hoxworth Ronald E, Thornton James F, Pessa Joel E
Dallas, Texas From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.
Plast Reconstr Surg. 2008 Jan;121(1):277-281. doi: 10.1097/01.prs.0000293880.38769.cc.
Several ligaments are believed to support the nasal tip. Intraoperative dissection has suggested that a broader ligament may exist along the pyriform rim than has been previously noted. This observation, along with the concept that pyriform rim shape may affect nasal tip projection by ligamentous fixation, led to the present study.
Ten hemifacial fresh cadaver dissections were performed. Sequential dissection was performed of tissue layers aided by magnification with loupes and an operating microscope. The fascial connection between pyriform rim bone and the upper and lower lateral cartilages and to the alar base was noted. The relationship of upper to lower lateral cartilage, and of the investing fascia to the lower lateral cartilage, was defined.
A dense fascial system was noted in all cadaver dissections arising from the periosteum of the pyriform rim. This ligamentous system inserted onto both the upper and lower lateral cartilages. It encompassed the previously described lateral sesamoid complex ligament and the ligament between the upper and lower lateral cartilage. This fascia has a consistent anatomical location and spans the pyriform rim from nasal bone to anterior nasal spine.
A ligament exists between the pyriform rim and lateral cartilages and is broader and more expansive than previously described. It encompasses the previously described lateral sesamoid complex and the ligament between the upper and lower lateral cartilages. The consistent anatomical origin of this membrane suggests that the term "pyriform ligament" may be appropriate nomenclature. This ligament may be important in translating anatomical shape--and distortion--of the pyriform rim to the nasal cartilages, and may therefore affect tip shape, tip projection, and nasal vault architecture.
人们认为有几条韧带支撑鼻尖。术中解剖显示，沿梨状孔边缘可能存在比先前所述更宽的韧带。这一观察结果，以及梨状孔边缘形状可能通过韧带固定影响鼻尖突出度的概念，引发了本研究。
进行了10例半侧面部新鲜尸体解剖。在放大镜和手术显微镜辅助下，对组织层进行顺序解剖。记录梨状孔边缘骨与上、下外侧软骨以及鼻翼基部之间的筋膜连接。明确了上、下外侧软骨之间的关系，以及包绕筋膜与下外侧软骨之间的关系。
在所有尸体解剖中均发现一个致密的筋膜系统，起自梨状孔边缘的骨膜。该韧带系统附着于上、下外侧软骨。它包括先前描述的外侧籽骨复合体韧带以及上、下外侧软骨之间的韧带。该筋膜具有一致的解剖位置，从鼻骨延伸至鼻前棘，跨越梨状孔边缘。
梨状孔边缘与外侧软骨之间存在一条韧带，其比先前描述的更宽、更广泛。它包括先前描述的外侧籽骨复合体和上、下外侧软骨之间的韧带。该膜一致的解剖起源表明，“梨状韧带”这一术语可能是合适的命名。该韧带在将梨状孔边缘的解剖形状及变形传递至鼻软骨方面可能很重要，因此可能影响鼻尖形状、鼻尖突出度和鼻背结构。
