Anatomy and Surgical Approaches to the Rabbit Nasal Septum
Anatomy and Surgical Approaches to the Rabbit Nasal Septum
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兔鼻中隔的解剖学和手术方法
DOI：
10.1001/jamafacial.2017.0116
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发表时间：
2017
影响因子：
--
通讯作者：
B. Wong
中科院分区：
文献类型：
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作者：
Karam W Badran;John C. Chang;E. Kuan;B. Wong
重要性：兔是研究鼻外科各方面的主要动物模型。虽然有几项研究使用了该模型，但没有一项研究对进入兔鼻窝和鼻中隔的外科解剖和技术进行了全面的分析。目的描述和优化兔鼻中隔软骨的手术解剖和入路。在一个学术医学中心进行的一项离体动物研究中，对兔头标本进行了初步的尸体解剖，以建立对相关解剖的熟悉并排练各种方法。使用活的无巴斯德氏杆菌新西兰白兔（3.5-4.0 kg）进一步发展本研究开发的手术技术。通过鼻背中线切口和用钻头制作成骨瓣进入鼻穹窿。粘膜下切除术并保留粘骨膜。术后4周，每天监测所有家兔的感染、疼痛和并发症的迹象。研究时间为2014年6月1日至2014年12月1日。主要结果和措施用于兔鼻穹窿和鼻中隔软骨切除的外科解剖和技术。结果采用4只无巴斯德氏杆菌新西兰白兔（Western Organ Rabbit Co），年龄9 ~ 12月龄，体重3.5 ~ 4.0 kg。初步解剖证明了在保留粘骨膜包膜的同时收获中隔软骨的可行性。通过3截骨入路进入鼻穹窿，可以最大限度地暴露双侧鼻腔，同时保持中隔软骨摘取后粘骨膜的完整性。获得的软骨最大体积为1.0 × 2.5 cm。手术解剖后，所有动物均保持足够的气道通畅和对面中部结构的支持。此外，所有标本都保存了粘骨膜、隔膜、血管解剖和气道动力学的完整性。无手术并发症、术后气道损伤或感染。结论与意义通过多种手术入路和技术进入兔鼻穹窿和鼻中隔软骨是可行的。迄今为止，这是第一个仔细记录和回顾兔鼻腔手术入路的研究。这种方法描述了一种新颖的，双侧进入鼻腔的三截骨方法，并成功地在粘液骨膜下平面上收获了兔鼻中隔软骨。保留原生解剖和功能的能力可以改善转化和动物指导临床研究的结果。证据水平NA。
Importance The rabbit is the primary animal model used to investigate aspects of nasal surgery. Although several studies have used this model, none has provided a comprehensive analysis of the surgical anatomy and techniques used to gain access to the rabbit nasal fossae and septum. Objective To describe and optimize the surgical anatomy and approach to the rabbit nasal vault and septal cartilage. Design, Setting, and Participants In an ex vivo animal study conducted at an academic medical center, preliminary cadaveric dissections were performed on rabbit head specimens to establish familiarity with relevant anatomy and rehearse various approaches. Live Pasteurella-free New Zealand white rabbits (3.5-4.0 kg) were used to further develop this surgical technique developed here. Access of the nasal vault was gained through a midline nasal dorsum incision and creation of an osteoplastic flap with a drill. Submucosal resection was performed with preservation of the mucoperichondrium. All rabbits were monitored daily for 4 weeks in the postoperative period for signs of infection, pain, and complications. The study was conducted from June 1, 2014, to December 1, 2014. Main Outcomes and Measures Surgical anatomy and techniques used to gain access to the rabbit nasal vault and harvest septal cartilage. Results Four Pasteurella-free New Zealand white rabbits (Western Organ Rabbit Co), ranging in age from 9 to 12 months and weighing between 3.5 and 4.0 kg, were used in this study. Initial dissections demonstrated the feasibility of harvesting septal cartilage while preserving the mucoperichondrial envelope. Access to the nasal vault through this 3-osteotomy approach allowed for maximal exposure to the nasal cavity bilaterally while maintaining the integrity of the mucoperichondrium following septal cartilage harvest. The maximum amount of bulk, en bloc, cartilage harvested was 1.0 × 2.5 cm. Following surgical dissection, all animals maintained adequate airway patency and support to midface structures. Furthermore, all specimens preserved the integrity of the mucoperichondrium, septum, vascular anatomy, and airway dynamics. No operative complications, postoperative airway compromise, or infections were observed. Conclusions and Relevance Access to the rabbit nasal vault and septal cartilage is feasible through a variety of surgical approaches and techniques. To date, this is the first study to meticulously document and review the surgical approaches to the rabbit nasal cavity. This approach describes a novel, 3-osteotomy method of accessing the nasal cavity bilaterally and successfully harvesting rabbit septal cartilage in a submucoperichondrial plane. The ability to preserve native anatomy and function allows for improved outcomes in translational and animal guided clinical research. Level of Evidence NA.