鼻翼软骨解剖学观测的临床意义

背景:鼻翼软骨是构成鼻下部1/3,即鼻尖、鼻翼和鼻小柱形状的主要成份,其结构对鼻部外形,尤其是鼻尖形状具有决定性作用.对鼻翼软骨进行深入细致地研究,有利于加深对鼻翼软骨形态、结构与功能的认识,帮助临床医生正确处理鼻下部病变及开展医学美容.目的:通过观测外鼻解剖结构,旨在阐明鼻翼软骨对鼻部外形,尤其是鼻尖形状的组织学作用.设计、时间及地点:重复测量观察实验,于2006-09-01/26在解放军第二军医大学解剖实验室完成.材料:保存完好的新鲜成年尸体15具,其中男性10具,女性5具.方法:为了全面观察外鼻的细微结构,解剖15具尸体30侧外鼻,解剖时由浅入深,从鼻背正中开始,分层解剖,观察鼻部血管所在层次及各层次特点,重点观察离体前及游离后鼻翼软骨的形态,并进行测量及记录.主要观察指标:鼻翼大软骨内侧脚、外侧脚及内外侧脚夹角测量值.结果:鼻翼软骨为一对呈开口向后的"u"形薄软骨板,位于侧鼻软骨下方,鼻翼的前内侧,由内、外侧脚和穹隆部构成;较薄,离体外形结构不大固定,穹隆部的形状难准确描述,大多呈波浪形或有皱褶.外侧脚呈菱形或长条形,长(16.21±2.71)mm,宽(8.45+1.72)mm,厚(1.09±0.18)mm,头缘与侧鼻软骨下缘相交,并略覆盖侧鼻软骨下缘使二者部分重叠,也可仅相交而无重叠;外侧脚构成鼻翼大部的基础;内侧脚狭细,构成鼻尖和鼻小柱前部的支架,呈向后下的弧形弯曲或S形弯曲.长(13.06±2.16)mm,宽(3.79±0.58)mm,厚(1.02±0.18)mm.左、右内侧脚在正中线借结缔组织相连,并以相同方式连于侧鼻软骨的前下缘.内、外侧脚在鼻尖部以锐角相交,其角度为(75.25±11.17)°,内、外侧脚在鼻尖部相交形成大翼软骨穹隆部,两侧穹隆部构成鼻尖部的支架.结论:鼻翼软骨菲薄,鼻翼软骨由内侧脚、外侧脚及穹隆部构成,其决定外鼻的形态,尤其是鼻尖的形态,外鼻整形中要注意保护鼻翼软骨.

Clinical significance of anatomic observation of the nasal alar cartilage

BACKGROUND: Nasal alar cartilage constitutes the main component of the lower 1/3 of the nose, that is, nose tip, nose wing, and nasal columella, its structure has a decisive role on the nose shape, especially the tip of the nose shape. The intensive study on nasal alar cartilage will help deepen our understandings of nasal alar cartilage morphology, structure and function, and help clinicians to correctly handle the lesions of nose and the lower part and to carry out medical beauty. OBJECTIVE: By observing external nasal anatomy, to clarify the histological role of nasal alar cartilage on nose shape, especially the nasal tip shape.DESIGN, TIME AND SETTING: Experimental observation of repeated measurement was conducted at the Laboratory of Anatomy, Second Military Medical University of Chinese PLA from September 1~(st) to 26~(th), 2006.MATERIALS: Well-preserved bodies of 15 fresh adult, containing 10 males and 5 females were used in this study.METHODS: To fully observe the fine structure of external nose, 30 sides of 15 external noses were dissected, and autopsy started from the medium dorsum of nose, layered anatomy, to observe various layers and the characteristics of the layers with blood vessels, focusing on observation of in vitro pre - and free post-nasal alar cartilage morphology, and measurement and recording were performed.MAIN OUTCOME MEASURES: Big foot medial alar cartilage, lateral feet and the angle of inside and outside legs were measured.RESULTS: Alar cartilage was open for a pair of backward "u"-shaped thin cartilage plate, and lateral nasal cartilage was located below and anteriomedialis the nose, was composed of medial and lateral crus and fornix, with thin body shape, unfixed structure. The shape of fornix was difficult to accurately describe; most presented wavy or folded. Lateral crus presented diamond-shaped or long strip, (16.21±2.71) mm in length, (8.45±1.72) mm in width, (1.09±0.18) mm in thickness. Cephalic rim intersected lower edge of lateral nasal cartilage, and slightly covered the lower edge of the lateral nasal cartilage, so that the two were overlapped, but also only the intersection without overlapping. Lateral crus constituted the base of nasal wings. Narrow medial crus formed nasal tip and the frame of front nasal columeila, showing posteroinferior curve or S shape, (13.06±2.16) mm in length, (3.79±0.58) mm in width, (1.02±0.18) mm in thickness. The left and right medial crus in the middle were connected by connective tissue, and in the same way connected to the anterior margin of the lateral nasal cartilage. Medial and lateral crus in the nasal tip showed an acute angle intersection, its angle (75.25±11.17)°. The medial and lateral crus intersected in the nasal tip and formed the fomix of the greater alar cartilage. The bilateral cornix constituted the frame of the nasal tip. CONCLUSION: Meager nasal alar cartilage is composed of the medial crus, lateral crus and fornix, which determined the nose shape, especially the nasal tip shape. External nose plastic surgery should pay attention to the protection of nasal alar cartilage.