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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4450_Библиотеки_им_академика_М_И_Перельмана
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as inspiratory air hitting the cul de sac will narrow the
valve slightly (▶ Fig. 1.96 and ▶ Fig. 1.97).
1.2.5Lobule
Interdomal Area
The area between the domes of the lobular cartilages is
filled with relatively dense connective tissue. On
macroscopic dissection, a sling of connective tissue
extending in a cranial direction and covering the triangular
paraseptal soft-tissue area (paraseptal cleft) can be seen (▶
Fig. 1.98). However, microscopic study reveals that there are
no transverse interdomal fibers. Most fibers run parallel to
the cartilage following their curvature (▶ Fig. 1.99 and ▶ Fig.
1.100). Whereas several authors have postulated an
interdomal “tip-supporting” ligament (or “Pitanguy
ligament”), no such structure appears to exist.
Nevertheless, loosening up the interdomal area too much
should be avoided, as this may lead to postoperative
broadening and drooping of the tip.
Fig. 1.98Macrodissection of a fresh specimen of the interdomal and intercrural region
using the external approach. Dome (1); medial crus (2); interdomal area (3).
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Fig. 1.99Interdomal area (transverse section through the lobular tip, RF staining).
Domes (1); interdomal area; no transverse interdomal fibers resembling a ligament;
most fibers run parallel to the cartilage (2); musculature (3).
Fig. 1.100High magnification of same area as ▶ Fig. 1.99 (RF staining). Domes of the
lobular cartilages (1); connective tissue fibers running parallel to the cartilage (2); fibers
of the transverse part of nasalis muscle (3). Note the small interdomal vessels.
Intercrural Area
The area between the two medial crura is filled with
relatively loose connective tissue. All fibers run parallel to
the cartilage. There are no transverse fibers
interconnecting the crura, as has been suggested by
certain authors. There is no such thing as an intercrural
ligament (▶ Fig. 1.101 and ▶ Fig. 1.102).
Fig. 1.101Intercrural area (transverse section at the level of the columella, RF
staining). Medial crura (1); connective tissue fibers following the course of the cartilage.
No transverse intercrural fibers (2).
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Fig. 1.102Intercrural area (coronal section through the lower part of the columella, RF
staining). Medial crus (1); intercrural loose connective tissue, no intercrural fibers (2).
Note the columellar artery.
Septocrural Area
The septocrural area consists of relatively loose connective
tissue. Contrary to assumptions in the literature, there are
no fibers directly connecting the caudal end of the septum
to the medial crura. There is no such thing as a septocrural
membrane (▶ Fig. 1.103 and ▶ Fig. 1.104).
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Fig. 1.103Septocrural area (coronal section through the anterior part of the lobule, RF
staining). Caudal end of the septum with its perichondrium (1); medial crura (2);
septocrural connective tissue (3).
Fig. 1.104Lobule and alae (coronal section through the anterior part of the lobule, MC
staining). Septum (1); triangular cartilage (2); lateral crus of lobular cartilage (3);
intercartilaginous area with sesamoid cartilage (4); caudal end of septum (5); medial
crura (6).
Alae
The alae consist of a thick outside skin with numerous
sebaceous glands, a thick subcutaneous layer, a muscular
layer, the lateral crus of the lobular cartilage, and the
relatively thin skin with glands and hairs covering the
vestibule (▶ Fig. 1.104 and ▶ Fig. 1.105).
Fig. 1.105High magnification of detail of ▶ Fig. 1.104. Thick outside skin with numerous
sebaceous glands (1); subcutaneous tissue (2); intermingling fibers of the dilator naris
(3); lateral crus of the lobular cartilage (4); vestibular skin with glands and hairs (5).
1.2.6Lobular Cartilages
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Cartilage
In the lobular cartilages, the difference between the small,
flat chondrocytes lying parallel to the surface in the
peripheral zone and the larger cells arranged palisade-like
perpendicular to the surface in the central zones is more
distinct than in the septal cartilage (▶ Fig. 1.106).
Fig. 1.106Lateral crus of lobular cartilage (MC staining). In the lobular cartilages, the
difference between the peripheral small and flat chondrocytes that are lying parallel to
the surface and the larger chondrocytes in the central zones that are positioned
palisade-like and perpendicular to the surface is even more distinct than in the septal
cartilage. See also ▶ Fig. 1.64.
Perichondrium
The perichondrium of the lobular cartilages consists of a
homogeneous layer of collagen fibers and elastic fibers. In
the lateral crus, the outer perichondrium is distinctly
thicker than the inner perichondrium. Thickness
measurements have shown a statistically significant
difference ([16]). This may be related to the difference
between the forces that are applied to the outer and the
inner side of the lateral crus of the lobular cartilage.
Muscle fibers of the dilator nasi attach to the outside only
(▶ Fig. 1.107).
Fig. 1.107Lateral crus of lobular cartilage (MC staining). The perichondrium of the
lobular cartilages consists of a homogeneous layer of collagen fibers and elastic fibers.
The outer perichondrium is distinctly thicker than the inner one. This is very likely
related to the difference between the forces that are applied to the outer and the inner
side of the lateral crus.
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