隆鼻层次及隆鼻术后鼻根部假体漂移的临床解剖学研究

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1、隆鼻层次及隆鼻术后鼻根部假体漂移的临床解剖学研究隆鼻层次及隆鼻术后鼻根部假体漂移的临床解剖学研究［摘要］目的：对鼻背部软组织层次进行解剖观察，了解鼻背部软组织特点，以进一步明确隆鼻的层次及隆鼻术后鼻根部假体漂移的解剖学基础。方法：选用10%福尔马林固定头颅标本20例，对标本行大体解剖，沿背部正中线切口逐层解剖，观察鼻背部的软组织层次，相机拍照。结果：鼻背部软组织层次依次分为皮肤、皮下组织、鼻背筋膜层、鼻背筋膜下疏松结缔组织、骨膜及软骨膜。鼻骨和侧鼻软骨结合处存在致密的纤维连接。降眉间肌大多起丁鼻骨骨膜,少数起于鼻肌横部。结论：以往所谓的骨膜下

2、隆鼻术实际上应称为双平面隆鼻术,即鼻根处假体置于鼻骨骨膜深层，鼻背、鼻尖部假体置丁鼻背筋膜深层；鼻背筋膜下隆鼻术则是整个假体都置于鼻背筋膜深层。在鼻背筋膜和鼻骨骨膜之间存在滑动层和降眉间肌大多直接起源于鼻骨骨膜可能是鼻背筋膜后间隙隆鼻术后鼻根部假体漂移的解剖学基础。建议手术分离隆鼻腔隙时在鼻骨段紧贴鼻骨锐性分离，破坏骨膜及其表面的滑动层,并完全离断降眉间肌在鼻骨骨膜的起点，以尽量避免发生鼻根部假体漂移O［关键词］鼻整形术;隆鼻；解剖；鼻背筋膜［中图分类号IR765.9R322［文献标识码］A［文章编号］1008-6455(2014)08-06

3、36-04ClinicalanatomicstudyoftheplaneofaugmentationrhinoplastyandthemobilityofimplantinnasalradixTIANJul,LIZhi-ming2,LUOZhi-junl,WANGHe-gengl,WUXiao-yunl(1.DepartmentofBurnsandPlasticSurgery,ZhongshanPeople，sHospital,Zhongshan528423,GuangDong,China;2.DepartmentofPlasticSurge

4、ry,TheFirstHospitalAffiliatedtoSunYat-senUniversity)Abstract：ObjectiveToobservethearrangementofnasalsofttissueandthecharactersofnasalsofttissue,inordertofurtherclarifytheplaneofaugmentationrhinoplastyandtheanatomicalbasisofthemobilityofimplantinnasalradix・MethodsTwentycases

5、of10%formalinfixedcadavericheads,thecadavernosesweredissectedgrossly.Layerbylayerseparationbythenasaldorsalmidlineincision.Toobservethelayersofnasalsofttissue,andtakephotographesResultsThesofttissueofnosecontain:skin,asuperficialfattylayer,nasalSMAS,aloosetissuelayer,aperio

6、steumandperichondrium・MostofTheprocerusmusclearisesfromnasalbone,othersarisefromtheaponeurosisofthetransverseportionofthenasalis・ConclusionsTheso-calledsubperiostealaugmentationrhinoplastyshouldactuallybecalledadualplaneaugmentationrhinoplasty.Theimplantofnasalrootbeplacedi

7、ndeepthenasalboneperiosteum・Theimplantofnasaldorsumandtipbeplacedindeepthenasaldorsalfascia,undernasaldorsalfasciaaugmentationrhinoplastyistheentireimplantwasplacedindeepthenasaldorsalfascia.TheglideplanbetweenthenasalSMASandperiosteumandmostofoftheprocerusmusclearisefromna

8、salbonemaybethereasonswhythemobilityoftheimplant・Sodissectionshouldbemaintaineddir