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面临最大风险:与鼻背动脉对峙对非手术隆鼻术的影响

Facing the Worst Risk

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【 文献重点摘要 】
 

Background: The nose is a dangerous site for filler injection. This study investigated the anatomy of the dorsal nasal artery at the upper part of the nose to clarify how ocular complications occur.

 

Methods: Dissections were performed in 50 noses of the embalmed cadavers. Either the soft embalming or formaldehyde embalming processes were used.

 

Results: The dorsal nasal artery is not a constant artery. The artery traveled in the subcutaneous tissue layer of the nasal dorsum on the transverse nasalis muscle and its midline nasal aponeurosis which connected the muscles on both sides. Bilateral dorsal nasal arteries existed only in 34%. In 28% of the specimens, a single and large dorsal nasal artery was presented. The diameter was 0.4 ± 0.2 mm when bilateral dorsal nasal arteries were present and 0.7 ± 0.3 mm in a single artery. The largest artery was 1.2 mm. The artery usually crossed the midline at the middle third part of the nose over the upper lateral cartilages to form an anastomosis with the contralateral lateral nasal artery as the oblique nasal artery in 14%. The artery might descend and communicate with the ipsilateral lateral nasal artery in 6% or descended as a midline artery and form the nasal tip plexus in 8%. In 38% of the specimens, the arteries became small, formed a subcutaneous plexus and randomly distributed on the superficial layer of the subcutaneous tissue in the upper two-thirds of the nose.

 

Conclusion: During the injections at the upper (bony) and middle (cartilaginous) part of the nose for nasal dorsal augmentation, the injector has to make sure the cannula tip is in the preperiosteal plane by reinsertion of the cannula if needed, due to the chance of encountering the large single dorsal nasal artery at the midline.

 

背景:鼻腔是注射填充物的危险部位。本研究调查了鼻上部鼻背动脉的解剖,以阐明眼部并发症是如何发生的。

 

方法:对50具防腐身体的鼻部进行解剖。采用软性防腐或甲醛防腐工艺。

 

结果:鼻背动脉不是恒定动脉。该动脉走行于鼻横肌及其中线鼻腱膜上的鼻背侧皮下组织层,连接两侧肌肉。双侧鼻背动脉仅占34%。在28%的标本中,有一条单一且较大的鼻背动脉。双侧鼻背动脉的直径为(0.4±0.2)mm,单动脉的直径为(0.7±0.3)mm。最大动脉直径1.2 mm。该动脉多在鼻中1/3处越过上外侧软骨与对侧鼻外侧动脉吻合,占14%。6%的动脉下降并与同侧鼻外侧动脉相通,8%的动脉呈中线动脉下降并形成鼻尖神经丛。38%的标本动脉变细,形成皮下神经丛,随机分布于鼻上2/3皮下组织的浅层。

 

结论:在鼻中上(骨)和中(软骨)部注射鼻背隆起术时,由于有机会在正中线遇到单个鼻背大动脉,注射器在必要时必须重新插入插管,以确保插管尖端位于骨膜前平面。

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