Finite Element Model Analysis of Cephalic Trim on Nasal Tip Stability.
Finite Element Model Analysis of Cephalic Trim on Nasal Tip Stability.
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DOI：
10.1001/jamafacial.2015.0941
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发表时间：
2015-11
影响因子：
--
通讯作者：
Wong BJ
中科院分区：
文献类型：
--
作者：
Leary RP;Manuel CT;Shamouelian D;Protsenko DE;Wong BJ
鼻翼缘回缩是由于过度切除头侧脚软骨导致的组织重塑的最常见的非预期后果;然而，产生这种形状变化的复杂组织重塑过程尚不清楚。模拟头侧修剪的切除如何改变人鼻内的应力分布，以响应鼻尖下压（触诊），并模拟头侧修剪后产生的内力，该内力可能导致鼻翼缘向头侧回缩和鼻尖向上旋转。一个多分量有限元模型，来自颌面部计算机断层扫描与1毫米的轴向分辨率。使用医学成像软件中的三维编辑功能修剪下外侧软骨的头部，以模仿典型鼻整形术中的操作。创建了三个模型：控制，保守修剪和积极修剪。将每个模拟模型导入到执行机械模拟的软件程序中，并分配材料特性。首先，模拟鼻尖凹陷（触诊），并计算每个模型的应力分布。其次，通过沿着组织缺损的尾部和头部边界放置法向力和剪切力矢量，在保守和激进修剪模型上模拟长期组织迁移。5 mm头端凹陷产生的von Mises应力分布显示所有3次模拟的结果一致，高应力区域集中在中间骨和尾侧隔的内侧部分。鼻尖反作用力随着切除更多的下外侧软骨组织而略微降低。保守和积极的头部修剪模型产生了一定程度的边缘收缩和头端旋转，这随着施加到组织缺损区域的力的大小而增加。在计算机化的人鼻复合模型上进行头部修剪，以模拟保守和积极的修剪。对每个模型施加内力，以模拟数十年伤口愈合导致的组织迁移。我们的模拟结果表明，头端旋转的程度和边缘回缩是取决于由于头部修剪切除的软骨量。头端反作用力随着组织切除量的增加而略微降低。NA.
Alar rim retraction is the most common unintended consequence of tissue remodeling that results from overresection of the cephalic lateral crural cartilage; however, the complex tissue remodeling process that produces this shape change is not well understood. To simulate how resection of cephalic trim alters the stress distribution within the human nose in response to tip depression (palpation) and to simulate the internal forces generated after cephalic trim that may lead to alar rim retraction cephalically and upward rotation of the nasal tip. A multicomponent finite element model was derived from maxillofacial computed tomography with 1-mm axial resolution. The 3-dimensional editing function in the medical imaging software was used to trim the cephalic portion of the lower lateral cartilage to emulate that performed in typical rhinoplasty. Three models were created: a control, a conservative trim, and an aggressive trim. Each simulated model was imported to a software program that performs mechanical simulations, and material properties were assigned. First, nasal tip depression (palpation) was simulated, and the resulting stress distribution was calculated for each model. Second, long-term tissue migration was simulated on conservative and aggressive trim models by placing normal and shear force vectors along the caudal and cephalic borders of the tissue defect. The von Mises stress distribution created by a 5-mm tip depression revealed consistent findings among all 3 simulations, with regions of high stress being concentrated to the medial portion of the intermediate crus and the caudal septum. Nasal tip reaction force marginally decreased as more lower lateral cartilage tissue was resected. Conservative and aggressive cephalic trim models produced some degree of alar rim retraction and tip rotation, which increased with the magnitude of the force applied to the region of the tissue defect. Cephalic trim was performed on a computerized composite model of the human nose to simulate conservative and aggressive trims. Internal forces were applied to each model to emulate the tissue migration that results from decades of wound healing. Our simulations reveal that the degree of tip rotation and alar rim retraction is dependent on the amount of cartilage that was resected owing to cephalic trim. Tip reaction force is marginally reduced with increasing tissue volume resection. NA.
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