隆鼻层次及隆鼻术后鼻根部假体漂移的临床解剖学研究  

Clinical anatomic study of the plane of augmentation rhinoplasty and the mobility of implant in nasal radix

作　　者：田举[1] 黎志明[2] 罗志军[1] 王和庚[1] 伍晓云[1] 

机构地区：[1]中山市人民医院烧伤整形科,广东中山528403 [2]广州中山大学附属第一医院整形修复外科

出　　处：《中国美容医学》2014年第8期636-639,共4页Chinese Journal of Aesthetic Medicine

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。降眉间肌大多起于鼻骨骨膜,少数起于鼻肌横部。结论:以往所谓的骨膜下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、鼻尖部假体置于鼻背筋膜深层;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。Objective To observe the arrangement of nasal soft tissue and the characters of nasal soft tissue,in order to further clarify the plane of augmentation rhinoplasty and the anatomical basis of the mobility of implant in nasal radix.Methods Twenty cases of 10% formalin fixed cadaveric heads,the cadaver noses were dissected grossly.Layer by layer separation by the nasal dorsal midline incision.To observe the layers of nasal soft tissue,and take photographes Results The soft tissue of nose contain：skin,a superficial fatty layer,nasal SMAS,a loose tissue layer,a periosteum and perichondrium.Most of The procerus muscle arises from nasal bone,others arise from the aponeurosis of the transverse portion of the nasalis.Conclusions The so-called subperiosteal augmentation rhinoplasty should actually be called a dual plane augmentation rhinoplasty.The implant of nasal root be placed in deep the nasal bone periosteum.The implant of nasal dorsum and tip be placed in deep the nasal dorsal fascia,under nasal dorsal fascia augmentation rhinoplasty is the entire implant was placed in deep the nasal dorsal fascia.The glide plan between the nasal SMAS and periosteum and most of of the procerus muscle arise from nasal bone may be the reasons why the mobility of the implant.So dissection should be maintained directly on the surface of bone and destroy the periosteum,resecting the origins of procerus muscle,in order to avoid the mobility of silicone augmentation.

关 键 词：鼻整形术 隆鼻 解剖 鼻背筋膜 

分 类 号：R765.9[医药卫生—耳鼻咽喉科] R322[医药卫生—临床医学]