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 the field. Skin and soft-tissue envelope preservation is of particular interest as it may prevent disassembly and reconstruction of the nasal tip. Ligamentous anatomy of the nasal tip has previously been described only through gross dissection, which is limited. The authors used high-definition magnetic resonance imaging (MRI) to provide a more complete anatomic description of the nasal tip ligamentous anatomy and applied this knowledge through their tip ligament preservation and suspension technique. 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 focused on identification of the origins, insertions, and courses of nasal tip ligaments. The group's tip ligament preservation technique was described. RESULTS: The cartilaginous (septum and lower lateral cartilages) and ligamentous (interdomal, intercrural, and Pitanguy) structures of the nasal tip were identified. The origins, insertions, and courses of these ligaments were analyzed and described further. Segmentation of nasal tip structures was completed to create a 3-dimensional model for further study. CONCLUSIONS: This is the first study to use high-definition MRI to define the nasal tip support ligaments. A 3-dimensional model was created to better understand structural relationships. Through anatomic analysis and technique description, surgeons will be better equipped to use skin and soft-tissue envelope preservation techniques of the nasal tip.

Duke Scholars

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

Author G. Allan Johnson Radiology

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

Author Hani Naga