The Pyriform Ligament

BACKGROUND: Several ligaments are believed to support the nasal tip. Intraoperative dissection has suggested that a broader ligament may exist along the pyriform rim than has been previously noted. This observation, along with the concept that pyriform rim shape may affect nasal tip projection by ligamentous fixation, led to the present study. METHODS: Ten hemifacial fresh cadaver dissections were performed. Sequential dissection was performed of tissue layers aided by magnification with loupes and an operating microscope. The fascial connection between pyriform rim bone and the upper and lower lateral cartilages and to the alar base was noted. The relationship of upper to lower lateral cartilage, and of the investing fascia to the lower lateral cartilage, was defined. RESULTS: A dense fascial system was noted in all cadaver dissections arising from the periosteum of the pyriform rim. This ligamentous system inserted onto both the upper and lower lateral cartilages. It encompassed the previously described lateral sesamoid complex ligament and the ligament between the upper and lower lateral cartilage. This fascia has a consistent anatomical location and spans the pyriform rim from nasal bone to anterior nasal spine. CONCLUSIONS: A ligament exists between the pyriform rim and lateral cartilages and is broader and more expansive than previously described. It encompasses the previously described lateral sesamoid complex and the ligament between the upper and lower lateral cartilages. The consistent anatomical origin of this membrane suggests that the term "pyriform ligament" may be appropriate nomenclature. This ligament may be important in translating anatomical shape--and distortion--of the pyriform rim to the nasal cartilages, and may therefore affect tip shape, tip projection, and nasal vault architecture.