McKinney P
Department of Plastic Surgery at Rush Presbyterian Medical School, Chicago, IL, USA.
Plast Reconstr Surg. 2000 Sep;106(4):906-17; discussion 918-21.
"Bulbous nose" is a term patients often use to describe a "ball" on the end of their nose. This ball can be caused by the abnormal anatomy of alar cartilage or by the overlying soft-tissue coverage. The purpose of this article is to analyze the different causes of bulbous noses and their treatment options. An analysis was done based on four decades of experience and long-term follow-up. We included 10 patients for our discussion. The relationship of the tip to the vault must be analyzed, because it can create optical illusions. For instance, a low bridge makes the tip appear larger; therefore, a bulbous nose may be relative. Similarly, excessive narrowing of the nasal base by alar wedges makes the tip appear wider. Intrinsic causes of a bulbous nose include skin, subcutaneous tissue (including the nasal superficial musculoaponeurotic system, ligaments, and fat), and the shape and direction of the individual crus. Nasal skin varies as to volume and ability to contract; therefore, the shape, direction, or divergence of the individual crura cannot undergo unlimited modifications. There are several surgical possibilities for a given problem. Making the diagnosis of the underlying abnormal anatomy is the most important step; then the most appropriate operation can be selected. Struts, sutures, resection, dome division, and/or dorsal augmentation are all viable options for the management of the bulbous nose.
“蒜头鼻”是患者常用来描述鼻尖上出现的“球状”外观的术语。这种球状外观可能由鼻翼软骨的解剖结构异常或上方软组织覆盖所致。本文旨在分析蒜头鼻的不同成因及其治疗方案。基于四十年的经验和长期随访进行了分析。我们纳入了10例患者进行讨论。必须分析鼻尖与鼻背的关系，因为这可能会造成视觉错觉。例如，鼻梁低会使鼻尖看起来更大；因此，蒜头鼻可能是相对的。同样，鼻翼楔形切除术过度缩窄鼻基底会使鼻尖看起来更宽。蒜头鼻的内在成因包括皮肤、皮下组织（包括鼻表浅肌肉腱膜系统、韧带和脂肪）以及各个鼻翼软骨脚的形状和走向。鼻皮肤在体积和收缩能力方面存在差异；因此，各个鼻翼软骨脚的形状、走向或分开程度无法进行无限制的改变。对于特定问题有多种手术方式可供选择。诊断潜在的解剖结构异常是最重要的步骤；然后可以选择最合适的手术方法。支撑物、缝线、切除术、穹窿分离和/或鼻背增高术都是治疗蒜头鼻的可行选择。
