Service de Chirurgie, ORL et Cervico-faciale, CHRU de Nancy, Université de Lorraine, Nancy, France.
Service d'Imagerie GUILLOZ, CHRU de Nancy, Université de Lorraine, Nancy, France.
Surg Radiol Anat. 2022 Oct;44(10):1367-1374. doi: 10.1007/s00276-022-03029-z. Epub 2022 Oct 8.
To study the anatomy of the latero-lateral joint (LLJ) between the upper lateral (ULC) and lower lateral (LLC) crus of the nasal cartilages, usually described as a scroll articulation.
Six nasal pyramids were taken in monobloc from fresh cadavers and imaged on micro-MRI with 0.4 mm slice thickness. Images were jointly interpreted by two head and neck radiologists and one surgeon. The junction between the ULC and LLC, the presence of ligaments and of sesamoid or accessory cartilages were assessed.
Eight LLJs could be analyzed, with four types of junctions: hook-shaped cephalic border of the LLC turned towards the nasal fossa and linear caudal border of the ULC (n = 3), hook-shaped caudal border of the ULC and linear cephalic border of the LLC lateral crus (n = 1), hook-shaped border of both cartilaginous edges with clinging (n = 1) (scroll articulation) or without clinging (n = 3). No ligament or sesamoid cartilage was found, but posterior accessory cartilages were seen in 75% of the cases.
The classical scroll articulation of the LLJ has been observed in only 1/8 cases on micro-MRI images. The anatomy of the LLJ could explain the surgical difficulty in raising the tip of the nose in some patients and not in others.
研究通常被描述为螺旋关节的鼻中隔侧-外侧关节（LLJ），即上外侧（ULC）和下外侧（LLC）鼻中隔软骨的侧-外侧连接。
从新鲜尸体中整块取出 6 个鼻锥体，并在 micro-MRI 上以 0.4mm 层厚进行成像。由两名头颈部放射科医生和一名外科医生共同解读图像。评估 ULC 和 LLC 之间的交界处、韧带的存在以及籽骨或副软骨的存在。
可以分析 8 个 LLJ，有 4 种连接类型：钩状 LLC 的颅侧缘朝向鼻腔，而 ULC 的尾侧缘为直线（n=3）；钩状 ULC 的尾侧缘和 LLC 侧脚的直线颅侧缘（n=1）；两个软骨缘的钩状缘具有附着（n=1）（螺旋关节）或没有附着（n=3）。未发现韧带或籽骨，但在 75%的病例中可见后副软骨。
在 micro-MRI 图像上仅观察到 1/8 例的经典 LLJ 螺旋关节。LLJ 的解剖结构可以解释为什么在某些患者中抬高鼻尖存在手术困难，而在其他患者中则不存在。
