Is Pitanguy’s ligament a true ligament? A prospective cohort study

Abstract

Aim: Facial region anatomically differs from other parts of the body by various structures it contains, for example, the superficial musculoaponeurotic system (SMAS). Among these structures, the most discussed is the dermocartilaginous ligament (DCL). There are some researchers who claim that this ligament is the continuity of the SMAS as well as those who consider it to be a separate ligament. Our aim is to determine whether the DCL, known as Pitanguy’s ligament, is a true ligament based on histopathologic findings.
Methods: Open technique rhinoplasty was performed to all 52 patients with nasal obstruction and deformity complaints. During the operation, specimens were excised from the tissues thought to be the DCL in all patients for histopathological examination, which was performed by pathologists.
Results: Gross findings during the operation revealed that in most of the 52 patients, white dense fibrotic tissue, considered the DCL, was observed in the middle part of the nose. During histopathological examination, vascularized fibromuscular tissue fragments were observed in one patient and edematous connective tissue components were seen in the others.
Conclusion: Based on our results and literature research, the presence of fibrous tissue components in the intermedial crural area demonstrates that the DCL is a true ligament, but the absence of regular dense fibrous tissue components in our histopathologic findings requires further histological studies. In addition, we believe that DCL should be preserved to obtain natural and functional noses in open technic rhinoplasties.