Anatomy of the Nasal Latero-lateral Cartilage Articulation: A Micro-MRI Study in Human Specimens.

Abstract

Purpose: To study the anatomy of the latero-lateral joint (LLJ) between the upper lateral (ULC) and lower lateral (LLC) crus of the nasal cartilages, usually described as a scroll articulation. Methodology: Six nasal pyramids were taken in monobloc from fresh cadavers and imaged on micro-MRI with 0.4 mm slice thickness. Images were jointly interpreted by two head and neck radiologists and one surgeon. The junction between the ULC and LLC, the presence of ligaments and of sesamoid or accessory cartilages were assessed. Results: Eight LLJs could be analyzed, with 4 types of junctions: hook-shaped cephalic border of the LLC turned towards the nasal fossa and linear caudal border of the ULC (n=3), hook-shaped caudal border of the ULC and linear cephalic border of the LLC lateral crus (n=1), hook-shaped border of both cartilaginous edges with clinging (n=1) (scroll articulation) or without clinging (n=3). No ligament or sesamoid cartilage was found, but posterior accessory cartilages were seen in 75% of the cases. Conclusion: The classical scroll articulation of the LLJ has been observed in only 1/8 cases on micro-MRI images. The anatomy of the LLJ couldexplain the surgical difficulty in raising the tip of the nose in some patients and not in others.

Nasal Sesamoid Cartilages: Fact or Fiction? An Anatomical Study of the Lateral Nasal Ala

“…In an assessment of 8 cadaveric specimens, Haddad et al found no evidence of sesamoid cartilages utilizing a micro-MRI approach, correlating with the present study, however, they did visualize posterior accessory cartilage in 75% of subjects. 8 Further, Rohrich et al completed a cadaveric study of 10 subjects seeking to define this anatomic area, noting a fascial complex encompassing the area between the upper and lower lateral cartilage, similar to the dense fibrous tissue visualized in this study. This variability should be further investigated, introduced into nasal anatomical renderings and incorporated into educational pursuits.…”