Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4450_Библиотеки_им_академика_М_И_Перельмана

Chondroperpendicular and Chondrovomeral Junction

Chondroperpendicular Junction

The posterior margin of the cartilaginous septum is fixed into a shallow groove of the anterior margin of the perpendicular plate. The type of junction between the septal cartilage and the perpendicular plate is unique in the human body. It is the only “articulation” where cartilage-covered and noncartilage-covered bone join. The septal perichondrium is continuous with the periosteum of the perpendicular plate. This stands to reason, as the perpendicular plate is the ossified posterior part of the primitive cartilaginous septum (▶ Fig. 1.73). Consequently, a posterior (subperiosteal) tunnel can be easily elevated from an anterior–superior (subperichondrial) tunnel.

Chondrovomeral Junction

The pear-shaped posterocaudal margin of the cartilaginous septum is fixed into a groove of the vomer. The junction is characterized by a very narrow gap with connective tissue fibers that are organized in a similar way to the chondropremaxillary junction. There are relatively more crossing fibers, however, which may explain why, during surgery, a mucosal tear may occur more easily at the chondrovomeral junction. The chondrovomeral junction allows some rotation when pressure is applied on the nasal dorsum, thus decreasing the risk of a fracture (▶ Fig. 1.74).

The mucoperichondrium consists of several different layers: (1) pseudostratified columnar ciliated epithelium with goblet cells and openings of the seromucous glands; (2) the lamina propria, or parenchymal layer, of varying thickness with seromucous glands, arterioles, venules, and nerve fibers; and (3) the perichondrium, consisting of connective tissue fibers running parallel to the cartilage. In the perichondrium, two layers may be distinguished: an outer layer of loosely arranged fibers with small arterioles, venules, and nerves; and an inner layer of densely packed fibers adjacent to the cartilage (▶ Fig. 1.75).

Incisive Nerve

The incisive nerve is a final branch of the nasopalatine nerve. It runs in a posterior–anterior direction in a narrow groove along the vomer parallel to its anterior border. It then passes under the wing of the premaxilla, curving down into the incisive canal of the premaxilla together with the artery and vein, and innervating a small triangular area behind the front teeth. In the septum, it is situated within the superficial layers of the periosteum (▶ Fig. 1.76 and ▶ Fig.