Guyuron Bahman, Ghavami Ashkan, Wishnek Sarah M
Division of Plastic and Reconstructive Surgery, Case Western Reserve University, Cleveland, Ohio, USA.
Plast Reconstr Surg. 2005 Oct;116(5):1517-24. doi: 10.1097/01.prs.0000182590.01431.3d.
The short nostril, best visualized on the basilar view, is a multifaceted dysmorphology that requires evaluation beyond that of alar/columellar deformities. While the soft triangle is the key component in short nostril disharmony, the alar rim and cartilaginous structures that border the nostrils play a salient role as well.
A retrospective review of 200 consecutive rhinoplasties (primary and secondary) examined the specific role of soft triangle excision and other components in the short nostril deformity. Twenty-seven patients underwent soft triangle excision with or without alteration of the other structures influential on nostril length. Of these 27 patients, only three patients required soft triangle excision alone.
The distance from the nostril apex to the caudal border of the alar dome was found to be the crucial element in defining the treatment approach for creating nostril length. When this distance was long, excision of the soft triangle lining and approximation of the alar rim to the lining under the dome elevated the nostril apex and elongated the nostril. When the distance between the nostril apex and overlying dome was ideal or short, soft triangle lining removal was not required, and an optimal nostril length was established by repositioning the other components. Raising the dome using transdomal sutures redirected the wide domal arch vertically, narrowing and lengthening the nostril, provided there was no redundancy in the soft triangle. In a similar fashion, interdomal sutures improved both nostril length and inclination. Placement of a columellar strut also elongated the nostril. An alar rim graft, used primarily to correct alar rim retraction and concavity, also elongated the short nostril.
The most important factor in analysis and treatment of the short nostril is the extent of the soft triangle tissue present. Soft triangle lining removal is indicated when the distance from the nostril apex to the caudal dome is excessive. This allows the nostril apex to be pulled anteriorly, thus elongating the nostril. The short nostril often coexists with multiple other abnormalities of the nasal base and tip, mandating a comprehensive approach to address all the deformities encountered. Correction of alar retraction also effectively increases nostril length. Further improvement of asymmetric tips and nostrils can be achieved through unilateral soft triangle lining excision with dome equalization through tip suturing and a subdomal graft.
短鼻畸形在基底位观察时最为清晰，它是一种多方面的形态异常，需要进行超出鼻翼/鼻小柱畸形评估范围的检查。虽然软三角是短鼻不协调的关键组成部分，但鼻翼边缘和鼻孔周围的软骨结构也起着重要作用。
对连续200例鼻整形手术（初次和二次）进行回顾性研究，以探讨软三角切除及其他成分在短鼻畸形中的具体作用。27例患者接受了软三角切除，同时或未改变其他影响鼻孔长度的结构。在这27例患者中，只有3例仅需进行软三角切除。
发现从鼻孔尖到鼻翼穹窿尾缘的距离是确定增加鼻孔长度治疗方法的关键因素。当这个距离较长时，切除软三角内衬并将鼻翼边缘与穹窿下的内衬贴合，可抬高鼻孔尖并延长鼻孔。当鼻孔尖与上方穹窿之间的距离理想或较短时，则无需切除软三角内衬，通过重新定位其他成分可建立最佳的鼻孔长度。使用跨穹窿缝线抬高穹窿可使宽阔的穹窿弓垂直重新定向，缩小并延长鼻孔，前提是软三角没有冗余。以类似方式，穹窿间缝线可改善鼻孔长度和倾斜度。放置鼻小柱支撑物也可延长鼻孔。鼻翼边缘移植主要用于纠正鼻翼边缘退缩和凹陷，也可延长短鼻。
短鼻分析和治疗中最重要的因素是软三角组织的范围。当从鼻孔尖到尾侧穹窿的距离过长时，应切除软三角内衬。这可使鼻孔尖向前牵拉，从而延长鼻孔。短鼻常与鼻基底和鼻尖的多种其他异常并存，因此需要采用综合方法来解决所有遇到的畸形。纠正鼻翼退缩也可有效增加鼻孔长度。通过单侧软三角内衬切除、通过鼻尖缝合和穹窿下移植使穹窿均等化，可进一步改善不对称的鼻尖和鼻孔。
