High Definition Magnetic Resonance Imaging of Nasal Tip Ligaments Illustrates Rationale for Ligamentous Preservation.

BACKGROUND: Although preservation rhinoplasty was described many years ago, it has recently been brought to the forefront of our field. Skin and soft tissue envelope (SSTE) preservation is of particular interest as it prevents the previously-accepted disassembly and reconstruction of the nasal tip. This ligamentous anatomy has only been described through gross dissection, which is limited. MRI of the nasal tip would give a more holistic understanding of this ligamentous anatomy. OBJECTIVES: To provide a more complete anatomic description of the nasal tip ligaments through high-definition MRI. Additionally, to apply this knowledge through our technique of tip ligament preservation and suspension. METHODS: Nasal specimens were harvested from cadavers and processed through a fixation and contrast protocol. Imaging of specimens was completed in a high-definition (55 µm) small-animal MRI scanner. Image analysis with focus on identification of insertion, origin, and course of nasal tip ligaments was completed by all authors independently. The group's tip ligament preservation technique was described. RESULTS: The cartilaginous (septum and lower lateral cartilages) and ligamentous (interdomal, intercrural, and Pitanguy's) structures of the nasal tip were identified. The insertion, origin, and course of the above ligaments was analyzed and further-described. Segmentation of nasal tip structures was completed to create a three-dimensional model for further study. CONCLUSION: This is the first study to utilize high-definition MRI to define the nasal tip support ligaments. A three-dimensional model was created to better understand structural relationships. Through anatomic analysis and technique description, surgeons will now be better-equipped to abide by SSTE preservation techniques of the nasal tip.

Duke Scholars

Author David Michael Stepien Surgery, Plastic, Maxillofacial, and Oral Surgery

Author Hani Naga  

Author Jeffrey Robert Marcus Surgery, Plastic, Maxillofacial, and Oral Surgery