注射隆鼻的安全平面:亚洲人鼻子中线纵切面的组织学分析
Safe Planes for Injection Rhinoplasty
【 文献重点摘要 】
Background
Dorsal nasal augmentation is an essential part of injection rhinoplasty on the Asian nose. Aesthetic physicians require detailed knowledge of the nasal anatomy to accurately and safely inject filler.
Methods
One hundred and thirty-five histological cross sections were examined from 45 longitudinal strips of soft tissue harvested from the midline of the nose, beginning from the glabella to the nasal tip. Muscles and nasal cartilage were used as landmarks for vascular identification.
Results
At the nasal tip, a midline longitudinal columellar artery with a diameter of 0.21 ± 0.09 mm was noted in 14 cadavers (31.1 %). At the infratip, subcutaneous tissue contained cavernous tissue similar to that of the nasal mucosa. The feeding arteries of these dilated veins formed arteriovenous shunts, into which retrograde injection of filler may be possible. All of the nasal arteries present were identified as subcutaneous arteries. They coursed mainly in the superficial layer of the subcutaneous tissues, with smaller branches forming subdermal plexuses. A substantial arterial anastomosis occurred at the supratip region, in which the artery lay in the middle of the subcutaneous tissue at the level of the major alar cartilages. These arteries had a diameter ranging between 0.4 and 0.9 mm and were found in 29 of 45 specimens (64.4 %). This was at the level midway between the rhinion above the supratip and the infratip. This anastomotic artery also crossed the midline at the rhinion superficial to the origin of the procerus on the lower end of the nasal bone. Here the arterial diameter ranged between 0.1 and 0.3 mm, which was not large enough to cause arterial emboli. Fascicular cross sections of the nasalis muscle directly covered the entire upper lateral cartilage. The subdermal tissue contained few layers of fat cells along with the occasional small artery. The procerus arose from the nasal bone and was continuous with the nasalis in 16 cadavers (35.6 %). There was fatty areolar tissue between the procerus and the periosteal layer and no significant arteries present. The procerus ascended beyond the brow to insert into the frontalis muscle with very few cutaneous insertions. The supratrochlear vessels and accompanying nerve were occasionally found on the surface of the frontalis muscle.
Conclusion
Most nasal arteries found in the midline are subcutaneous arteries. Filler should be injected deeply to avoid vascular injury leading to compromised perfusion at the dorsum or filler emboli at the nasal tip.
Keywords
Dorsal augmentation, Filler injection, Nasal artery, Histology
背景
背侧隆鼻是亚洲人鼻部注射隆鼻术的重要组成部分。美容医生需要详细的鼻腔解剖知识,以准确和安全地注射填充物。
方法
从眉间到鼻尖,从鼻中线切取45根软组织纵条,观察135个组织学断面。肌肉和鼻软骨被用作血管识别的标志。
结果
14具尸体(31.1 %)在鼻尖发现一条直径为0.21±0.09毫米的中线纵行小柱动脉。在鼻尖下,皮下组织包含类似于鼻粘膜的海绵状组织。这些扩张静脉的供血动脉形成了动静脉分流,向其中逆行注射填充剂是可能的。所有存在的鼻动脉都被确定为皮下动脉。它们主要在皮下组织的浅层行进,较小的分支形成皮下丛。实质上的动脉吻合发生在鼻尖上区域,其中动脉位于大鼻翼软骨水平的皮下组织的中间。这些动脉的直径在0.4到0.9毫米之间,在45个标本中的29个标本中发现(64.4 %)。这是在上鼻尖和下鼻尖之间的中间位置。该吻合动脉也在鼻骨下端的降眉骨起点的鼻浅处穿过中线。动脉直径在0.1到0.3毫米之间,不足以引起动脉栓塞。鼻肌的束状横截面直接覆盖整个上外侧软骨。真皮下组织包含几层脂肪细胞以及偶尔出现的小动脉。降眉骨起源于鼻骨,在16具尸体(35.6 %)中与鼻肌相连。降眉骨和骨膜层之间有脂肪乳晕组织,无明显动脉存在。降眉骨升至眉骨之外,插入额肌,极少有皮肤插入。额肌表面偶尔可见滑车上血管和伴随神经。
结论
中线处的鼻动脉多为皮下动脉。填充剂应深度注射,以避免血管损伤导致背部灌注受损或鼻尖填充栓塞。
关键字
背侧扩张术;填充物注射;鼻动脉;组织学