The Study Of Applied Anotomy Of External Nose For Plastic Surgery

Objective:Rhinoplasty is a kind of usual operations in department of plastic surgery.Rhinoplasty also is one of difficult operations in plastic surgery, because the nasal anatomy is complex, and the structures are variant, and the operations must ensure that the physiological functions of the nose are not impaired, together with more stringent requirements of postoperative appearance. Thereinto,the anatomy of nose is the main difficult factor in nasal reconstructive surgery, lack of understanding of that also resulte in some unexpected postoperative adverse effects, and even serious complications.Therefore, well-known nasal anatomy and nuances of anatomic variations can make us to understand the aesthetics of some nasal structure, and to obtain the capacity of treating anatomic variations, and to achieve the coordination of nasal function and nasal appearance,and at last to ensure that the operation is successful and the effect is lasting. But compared abroad, a few domestic researchs are about clinical application of rhinoplasty anatomy currently and there are not a formed systematic understanding. A part of plastic surgeons are relying on the anatomical datas abroad, operation techniques abroad and personal clinical experiences to perform rhinoplasty operations.To some extent, this phenomenon results in some operation blindness, and post-op effects can be imagined. So our aim is to observe and measure the gross and histological of nasal specimens of formalin-treated cadaver, and nasal bone of skull,and to summarize the datas of applied anatomy of Chinese nose which provide a reliable basis theory for the rhinoplasty.Methods:We applied techniques of gross anatomy and histology observation. There were 20 formalin treated adult cadavers(16 males,4 females).And the nasal tip blood supply type, alar cartilage and its linked surrounding structure are observed or measured. And It is observed by histological examination that lateral alar cartilage and lateral crus of connection between the nasal cartilage, nasal cartilage and surrounding soft tissue composition of the other 3 cases (4 sides) male body. Second, skull specimens of 80 cases of nasal bone are observed and measured. Focus on observation, measurement and analysis of the surgery related nasal bone.Results:1.Skin and soft tissue anatomy on nose back:thickest soft tissue in the nasal dorsum is at the area of radix and supratip, and the thinnest is at keystone zone. Skin, bone and cartilage are foamed by four layers:superficial layer of fat, fiber muscle layer, deep layer of fat, periosteum or perichondrium. Nasal skin and subcutaneous tissue have different anatomical characteristics in the bone area, the upper cartilage zone, and the lower part of cartilage.2.Nasal tip blood supply category:①unilateral lateral nasal artery,10%(2 cases);②bilateral lateral nasal artery,40%(8 cases);③unilateral nasal dorsum artery,20% (4 cases);④double side of the dorsum artery,5%(1 case);⑤unilateral nasal dorsum and lateral nasal artery artery,25%(5 cases).3.Nasal muscle:the nose is almost completely covered by a thin layer of muscle, which is formed by nasalis, procerus muscle, irregular muscle, dilatator naris, nostril muscle contraction, levator labii superioris alaeque nasi muscle.4. Alar cartilage:4.1 Alar cartilage of the correlation measurements:both sides of alar cartilage dome width was (6.36±1.26) mm, the maximum length of left lateral crura of alar cartilage(18.60±3.06) mm, the maximum length of right lateral crura of alar cartilage(18.02±3.86) mm, the maximum width of left lateral crura of alar cartilage (8.83±1.34) mm,the maximum width of right lateral crura of alar cartilage (8.67±1.23) mm, the thickness of left lateral crura of alar cartilage (0.55±0.05) mm, the thickness of right lateral crura of alar cartilage (0.54±0.06) mm, the trailing edge of domal segment of the left alar cartilage from the nostril rim were (4.26±0.79) mm, the trailing edge of domal segment of the right alar cartilage from the nostril rim were (4.36±1.21)mm, the trailing edge mid-point of left alar cartilage from the nostril rim were (6.99±1.43)mm, the trailing edge mid-point of right alar cartilage from the nostril rim were (6.66±1.63) mm, the farthest-ended of trailing edge of left alar cartilage from the nostril rim were(14.13±3.34) mm, the farthest-ended of trailing edge of right alar cartilage from the nostril rim were(13.57±2.68) mm, the middle of the left alar cartilage foot length (4.76±0.69) mm, the right alar cartilage in the middle of foot length (4.80±0.86) mm, the left alar cartilage of the medial foot length(13.97±1.10) mm, the right alar cartilage medial foot length(13.91±1.10) mm.4.2 The grossly observed of alar cartilage:Lateral crura of alar cartilage in five feet of gross morphological types:①convex type, accounting for 20%(8 sides);②concave,38%(15 sides);③convex-concave,10%(4 side);④concave-convex type, accounting for 25%(10 sides);⑤flat type, accounting for 7% (3 sides).4.3 Alar cartilage and its surrounding structure to connect the gross anatomy: Alar cartilage and surrounding soft tissue connections can be divided into upper, inner world, the outside world and its deep, superficial.Thereinto, the cephalic edge of the lateral crus and the caudal edge of the upper lateral cartilage have four connection types:①overlapping crimp type, accounting for 57.5%(23 sides);②simple duplication without curly type, accounting for 20%(8 sides);③edge of the edge type, accounting for 12.5%(5 sides);④two cartilage margin of separation types, accounting for 10%(4 sides).4.4 The statistical results:alar cartilage of all the left and right sides of the data by paired sample t tests were after, P>0.05,the bilateral data were not statistically significant.5. Related measurement results of the upper lateral cartilages:the overlapping length between the left side of upper lateral cartilages and nasal bone was (5.78±3.05)mm, the overlapping length between the right side of upper lateral cartilages and nasal bone was (5.81±3.38)mm, the left side length of the cephalic edge of upper lateral cartilages was (10.28±2.86)mm, the right side length of the cephalic edge of upper lateral cartilages was (10.47±2.75)rrim, the left side length of the caudal edge of upper lateral cartilages was (15.25±2.76)mm, the right side length of the caudal edge of upper lateral cartilages was (15.57±2.48)mm, the overlapping length between the nasal septum cartilage and nasal bone was (8.25±2.10)mm, lateral nasal cartilage to the nasal point trailing edge distance (18.13±2.87)mm, the intersection point of the caudal edge of upper lateral cartilages and septal cartilage to rhinion distance (18.13±2.87)mm.5.2 The statistical results:the upper lateral cartilages of all the left and right sides of the data by paired sample t tests were after, P> 0.05,the bilateral data were not statistically significant.6. Inner canthal ligament6.1 Measurement of the medial canthal ligament:Inner canthal ligament of the right nasal attachment dot pitch on the right edge of the medial orbital distance (3.96±0.58) mm, inner canthal ligament of the right nasal attachment dot pitch on the right edge of the medial orbital distance (3.96±0.7) mm.6.2 The statistical results:all the left and right sides of the data by paired sample t tests were after, P> 0.05,the bilateral data were not statistically significant.7. Skull specimen measurement data:7.1 male data:Left frontal nasal suture length (5.15±1.52) mm, the right amount of nasal suture length (5.43±1.66) mm, the left lateral margin of nasal bone length (27.91±2.54) mm, right lateral margin of nasal bone length (27.96±3.02) mm, nasal bone length (24.34±2.07) mm, the bottom of the left nasal suture to the nasal bone in the joint at the bottom of the distance (11.11±1.47) mm, the bottom of the right nasal suture to the nasal bone in the joint at the bottom of the distance (11.34±1.22) mm, inner canthal ligament attachment points connected to the nasal bone nasal point distance (16.72±2.10) mm, the thickness of the left point of the rhinion (0.79±0.14) mm, the thickness of the right point of the rhinion (0.81±0.21)mm, the left nasomaxillary groove to the left orbital margin of jaw ditch the minimum width (3.29 ±0.70) mm, the right nasomaxillary groove to the left orbital margin of jaw ditch the minimum width (3.28±0.75) mm the left minimum point of orbit and the point of left inferior turbinate attachment to the vertical distance between horizontal (9.94±1.97) mm, the left minimum point of orbit and the point of left inferior turbinate attachment to the vertical distance between horizontal (10.18±1.69) mm.7.2 Women data:Left frontal nasal suture length (5.37±1.52) mm, the right amount of nasal suture length (5.02±1.24) mm, the left lateral margin of nasal bone length (26.23±2.64) mm, right lateral margin of nasal bone length (26.68±3.01)mm, nasal bone length (23.27±1.98) mm, the bottom of the left nasal suture to the nasal bone in the joint at the bottom of the distance(10.91±1.45) mm, the bottom of the right nasal suture to the nasal bone in the joint at the bottom of the distance (10.93±1.41) mm, inner canthal ligament attachment points connected to the nasal bone nasal point distance (15.47±.15) mm, the thickness of the left point of the rhinion(0.70±0.13)mm, the thickness of the right point of the rhinion (0.73±0.17) mm, the left nasomaxillary groove to the left orbital margin of jaw ditch the minimum width (3.41±0.70) mm, the right nasomaxillary groove to the left orbital margin of jaw ditch the minimum width (3.39±0.60) mm the left minimum point of orbit and the point of left inferior turbinate attachment to the vertical distance between horizontal(9.91±2.16)mm,the left minimum point of orbit and the point of left inferior turbinate attachment to the vertical distance between horizontal(10.21±2.32)mm.7.3 The statistical results:male and female specimens of the nasal bones on the sample t-test matched data, P>0.05,its bilateral data were not statistically significant. In the male and female gender of independent samples t-test, the nasal bone length, the thickness of nasal point, inner canthal distance to connect to the nasal point P <0.05,the male values greater than female, with statistical significance, while the rest had no statistics significance, no difference between men and women.Conclusion:1.Artery nasal tip type, in addition to bilateral and unilateral nasal dorsum dorsum artery blood supply artery for blood (a total of 25%), the other type in both the lateral nasal artery supplying blood to the nasal tip, suggesting that patients should pay attention to the protection of the lateral nasal artery, to protect the nasal tip blood supply;2.This study showed that the alar cartilage size, shape and composition of the surrounding support structure are quite different compare with Caucasian, and it have important significance that choose suitable for our nation's rhinoplasty style;3.Under the eyes the most points as the base line of the horizon, the next turbinate attachment point above the baseline of not more than 10mm from the start at low osteotomy, along the frontal process of maxillary bone changes in the department of transition zone up, and maintain and orbital wall distance of at least 3mm above, can reduce the osteotomy Vice damage caused.