Gruber Ronald P, Freeman M Brandon, Hsu Charles, Elyassnia Dino, Reddy Vikram
Stanford, San Francisco, and Davis, Calif.; and Providence, R.I. From the Divisions of Plastic and Reconstructive Surgery of Stanford University, University of California, San Francisco, Brown University, and University of California, Davis.
Plast Reconstr Surg. 2009 Feb;123(2):709-715. doi: 10.1097/PRS.0b013e318196bc11.
When reducing the broad nasal base, there is a limit to the amount of soft tissue that can be resected, beyond which the anatomy distorts and the nostrils become stenotic (if resection enters the nostril). Alar mobilization by freeing soft-tissue attachments helps. This study purported to examine the nature of those attachments and the extent of medialization.
The supporting tissues of the ala were sequentially divided in 16 fresh hemifacial cadavers. Key structures included the following: (1) the soft tissues and pyriform ligament of the anterior maxilla, (2) the periosteum posterior to the pyriform rim (in the bony nasal vault), and (3) the soft tissues along the horizontal pyriform rim. After release of each tethering region, the ala-pyriform distance was measured.
After releasing the anterior maxillary periosteum and pyriform ligament along the vertical pyriform rim, the ala-pyriform distance was reduced by a mean of 1.9 mm. After releasing the periosteum posterior to the pyriform rim (in the nasal vault), it was reduced by a mean of 1.7 mm. Releasing the soft tissues (which were thick medially) of the horizontal pyriform rim reduced the mean distance 1.0 mm for a total of 4.6 mm. Medialization resulting from anterior and posterior releases was significantly greater than that from the horizontal pyriform rim (p < 0.0006 and p < 0.015, respectively), but they were not significantly different from one another.
This cadaver study confirmed the role of the stabilizing effect of the pyriform ligament and the periosteum lateral and posterior to the pyriform rim. The total release was substantial, suggesting a clinical means of achieving tension-free alar medialization.
在缩窄宽阔的鼻基底时，可切除的软组织量存在限度，超过此限度会导致解剖结构变形，鼻孔变窄（若切除范围进入鼻孔）。通过松解软组织附着来进行鼻翼活动度改善有帮助。本研究旨在探究这些附着的性质及内移程度。
在16具新鲜半侧面部尸体上依次分离鼻翼的支持组织。关键结构包括：（1）上颌骨前部的软组织和梨状韧带；（2）梨状缘后方（鼻骨穹窿部）的骨膜；（3）沿水平梨状缘的软组织。在每个束缚区域松解后，测量鼻翼-梨状缘距离。
沿垂直梨状缘松解上颌骨前部骨膜和梨状韧带后，鼻翼-梨状缘距离平均减少1.9毫米。松解梨状缘后方（鼻穹窿部）的骨膜后，平均减少1.7毫米。松解水平梨状缘的软组织（内侧较厚）使平均距离减少1.0毫米，总计减少4.6毫米。前后松解导致的内移显著大于水平梨状缘松解所致（分别为p < 0.0006和p < 0.015），但二者之间无显著差异。
本尸体研究证实了梨状韧带以及梨状缘外侧和后方骨膜的稳定作用。总的松解幅度较大，提示存在一种实现无张力鼻翼内移的临床方法。
