Chiu Tor
Plastic Reconstructive and Aesthetic Surgery, The Chinese University of Hong Kong, Hong Kong.
Acta Otorhinolaryngol Ital. 2025 Jun;45(3):192-199. doi: 10.14639/0392-100X-N2159.
The aim of this study was to elucidate the anatomical factors influencing elongation of the pedicle of the nasoseptal flap (NSF).
Dissections were conducted on tissue blocks taken from 61 embalmed half-heads. In the first group, 36 were microdissected to delineate the configuration of the third part of the maxillary artery (MA). In the second group, 25 other specimens were dissected using endoscopic instruments to determine the tethering points limiting the mobility of the NSF and to document the surgical manoeuvres required for release.
The MA is coiled in the pterygopalatine fossa (PPF) into a variety of configurations that can be classified into single-looped (SL) or double-looped (DL) forms depending on the number of vessel loops. Up to 4.7 ± 0.5 cm of NSF pedicle elongation is possible in the more common (80.8%) DL forms. Elongation is limited to 2.6 ± 0.5 cm in the SL form; greater palatine artery transection is more important to pedicle elongation in the SL form. Posterior branches such as the pharyngeal and vidian arteries may hinder pedicle elongation.
The pedicle of the NSF may be elongated by up to 5 cm, greatly increasing its potential utility. The vessel length available for elongation is determined by the extent of MA looping, while the branch configuration, and particularly the origins of the posterior branches, determine how difficult the process will be.
本研究旨在阐明影响鼻中隔瓣（NSF）蒂部延长的解剖学因素。
对取自61个防腐处理的半头颅的组织块进行解剖。第一组，对36个组织块进行显微解剖，以描绘上颌动脉（MA）第三部分的形态。第二组，对另外25个标本使用内镜器械进行解剖，以确定限制NSF活动的束缚点，并记录松解所需的手术操作。
MA在上颌后窝（PPF）盘绕成多种形态，根据血管环的数量可分为单环（SL）或双环（DL）形式。在更常见的（80.8%）DL形式中，NSF蒂部可延长达4.7±0.5厘米。在SL形式中，延长限制在2.6±0.5厘米；在SL形式中，切断腭大动脉对蒂部延长更为重要。咽动脉和翼管动脉等后支可能会阻碍蒂部延长。
NSF的蒂部可延长达5厘米，极大地增加了其潜在用途。可用于延长的血管长度由MA的盘绕程度决定，而后支的形态，尤其是后支的起源，决定了该过程的难易程度。
