Hall Jeffrey A, Peters Michael D, Hilger Peter A
Department of Otolaryngology--Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, University of Minnesota, Minneapolis, USA.
Arch Facial Plast Surg. 2004 Mar-Apr;6(2):105-10. doi: 10.1001/archfaci.6.2.105.
Preservation of the middle nasal vault has increasingly become a topic of interest and concern in rhinoplasty. Modification of the nasal dorsum with traditional techniques may create unfavorable cosmetic results and adverse functional sequelae due to collapse of the middle nasal vault. Nasal dorsal reduction invariably involves separating the upper lateral cartilage (ULC) attachments from the dorsal septum. A number of procedures are used to reestablish the width of the middle nasal vault and competence of the internal nasal valve. Spreader grafts are the most frequently used technique. Although these grafts reliably preserve the middle vault, dorsal irregularities may result. Alternative techniques, such as suture suspension of the ULCs to dorsal onlay grafts or direct suturing of the ULCs to the septum, may pose similar problems. We have found that a modification of the Skoog technique for dorsal hump reduction preserves both a favorable aesthetic contour of the middle nasal vault and proper function of the internal valve. This procedure involves removal of the osseocartilaginous dorsum en bloc. The nasal dorsum is further reduced; the removed portion of nasal dorsum is sculpted and then replaced anatomically. Once a favorable position is found for the native dorsal graft, the upper lateral cartilages are resuspended to the graft with suture fixation. The dorsal segment thus acts as a dorsal onlay spreader graft, reestablishing a natural dorsal contour and preserving the middle nasal vault. We can avoid osteotomies in patients with an appropriate preoperative width of their bony base while correcting the open roof with the replaced dorsal segment.
在鼻整形术中，中鼻拱的保留日益成为一个备受关注的话题。采用传统技术对鼻背进行整形可能会因中鼻拱塌陷而产生不理想的美容效果和不良的功能后遗症。鼻背降低术总是涉及将上外侧软骨（ULC）与鼻中隔背部分离。有多种手术方法用于重建中鼻拱的宽度和鼻内瓣膜的功能。撑开移植是最常用的技术。尽管这些移植能可靠地保留中鼻拱，但可能会导致鼻背不规则。其他技术，如将ULC缝合悬吊至鼻背覆盖移植片或直接将ULC缝合至鼻中隔，可能也会出现类似问题。我们发现，对Skoog鼻背驼峰降低技术进行改良，既能保留中鼻拱良好的美学轮廓，又能维持鼻内瓣膜的正常功能。该手术包括整块切除骨软骨性鼻背。进一步降低鼻背；将切除的鼻背部分进行塑形，然后按解剖位置重新放置。一旦找到天然鼻背移植片的合适位置，就用缝线固定将上外侧软骨重新悬吊至移植片上。这样，鼻背段就起到了鼻背覆盖撑开移植片的作用，重建了自然的鼻背轮廓并保留了中鼻拱。在通过重新放置的鼻背段矫正开放性鼻骨时，对于术前鼻骨基底宽度合适的患者，我们可以避免进行截骨术。
