Nostrilplasty by Manipulating the Dilator Naris Muscles: A Pilot Study

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We wanted to thank Jung et al.1 for describing such an interesting surgical method of alar contour definition in Asian people by means of the manipulation of dilator naris muscles. Contradictory findings appear in the literature about dilator muscle descriptions and denomination. We would like to share our own anatomical and histologic experience, to highlight the problem of muscle denomination and the question of reproducibility of alar muscle surgery, based on reviews and dissections of three elderly Caucasian cadavers.
The dilatator naris was not reported by name in the Terminologia Anatomica published in 1998.2 Short reviews show the lack of consensus of final denomination of the dilator naris muscles in general, and the dilatator naris in particular.2–5 The dilatator naris was reported as a single, independent muscle, considered “the smallest, the palest, the most adherent muscle of the face” by Sappey in 1876.6 It was a permanent muscle with variability in Caucasians: fibers could be strong or could require microscopic dissection, and the fibers were often atrophic with fatty tissue in the elderly.6 According to its triangular shape and its insertions, it could be considered as the musculus dilatator naris anterior reported by Letourneau and Daniel.3 This muscle is not reported in the study of Breitsprecher et al.4 To make our point, we proceeded in the dissection of three fresh Caucasian cadavers in a special way: after progressing in a subperiosteal way under the facial mask up to the piriform rim, we opened the periosteum from it deepest part to its most superficial part to open the anatomical alar compartment like a book. When performed in this way, we always found one dilatator naris (Fig. 1): it was a single and independent muscle filling the entire alar compartment, with fibers arising from the periosteum of the piriform rim and connective tissue of the triangular-alar junction to the skin of the nostril margin. Fibers from the pars alaris of the nasalis were perpendicular to the dilatator naris. Histologic study (Fig. 2) showed the directions of the fibers in a Caucasian person. Final findings converged to form the description of the dilatator anterior naris from Hur et al.5 We did not find fibers clearly corresponding to the dilator naris vestibularis in our population.
In our mind, the name dilatator naris should be reserved to describe this permanent and independent muscle, reported by Letourneau and Daniel and the authors as the dilator naris anterior to avoid confusion with the pars alaris of the nasalis, namely, retained in the Federative Committee on Anatomical Terminology consensus,2 which is variable among world populations and dependent on other facial muscles that may criss-cross it.1,3–5 The dilatator naris seemed to be the muscle mainly manipulated by the Jung et al. technique.1
According to these findings, we think that Caucasian people, who have clinically strong components of permanent dilatator naris tone in alar morphology, could benefit from dilatator naris transposition if the functional assessment of nasal ventilation is confirmed. The article by Jung et al. allows hope for new physiologic and efficient ways of performing rhinoplasty.
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