宽鼻缩窄截骨术的临床应用解剖

Applied anatomy of broad nasal bone reduction

目的为更好地开展鼻背缩窄截骨术并减少其并发症提供解剖学基础。方法10例20侧防腐成人头部标本用局部解剖的方法观察鼻背骨结构与周围组织的比邻关系。结果鼻背骨结构由鼻骨、上颌骨鼻突、额骨鼻突组成。其中:(1)鼻骨间缝合长度(25.2±2.91)mm;(2)鼻颌缝合长度(29.2±2.51)mm;(3)上颌骨鼻突厚度①梨状孔起点处(1.86±0.22)mm,②眶下缘平面(2.18±0.22)mm,③内眦平面(2.78±0.10)mm;⑷鼻颌沟到鼻泪管之间的距离①顶部(3.52±1.22)mm,②中部(5.10±1.48)mm,③底部(5.62±1.26)mm;⑸内眦韧带止点与鼻颌缝的距离(2.87±0.08)mm。结论鼻背缩窄的侧鼻安全截骨线为:截骨术要从下鼻甲上部的附着部位开始,于骨膜下沿鼻颌沟进行,避开鼻外侧静脉,于眼窝内下方大约相距3.5mm左右,到鼻根点部位于内侧截骨线相遇。

Objective To provide anatomicalbasisfor broad nasal bone reduction. Methods Clinical surgical dissection of nasal dorsum was studied bilaterally on 10 embalmed cadaveric head specimens. Results Nasal dorsum involved in nasal bone,nasal process of maxilla,and nasal process of frontal bone. The suture line length of nasal bone was about （25.2±2.91）mm,and suture line length of nasomaxillary （29.2±2.51）mm. The thickness of nasal process of maxilla at the level of piriform aperture was about （1.86±0.22）mm,at the level of the infraorbital border （2.18±0.22）mm,and at the level of medial canthal ligaments （2.78±0.10）mm. The distance between nasomaxillary groove and nasolacrimal duct was （3.52±1.22）mm for superior part,（5.10± 1.48）mm for middle part and （5.62±1.26）mm for inferior part respectively. The distance from the midpoint of insertion of the anterior branch of the medial canthal ligament to the nasomaxilloric suture was （2.87±0.08） mm. Conclusions For osteotomies of broad nasal bone reduction,the lateral incision have to be made from the superior part of inferior nasal concha,along with nasomaxillary groove under the periosteum and leaving the nasal lateral vein,reach to nasal root for meeting with medial incision,which is about the 3.5mm near the medial inferior aspect of orbital margin.