Jameson John J, Perry Adam D, Ritter Edmond F
Division of Otolaryngology, Caritas St. Elizabeth's Medical Center, Boston, MA, USA.
Ann Plast Surg. 2006 Jan;56(1):40-5; discussion 45. doi: 10.1097/01.sap.0000192414.86895.c2.
When attempting to straighten a patient's healed, deviated bony nasal dorsum, deviation of the central structure (high dorsal septum and medial nasal bones) must be addressed following the completion of medial and lateral osteotomies. When hump resection is not performed, blunt fracture (digitally or with forceps) of the deviated central structure is not a reliable method of mobilization, often leading to postoperative nasal drift. An intranasal osteotomy technique to mobilize the central structure of the nose is described, called "high septal osteotomy." Review of 25 cases suggests high septal osteotomy, supplemented as needed by resection of overlapping septal elements, can be performed safely and efficaciously, permitting stable midline reduction of the nasal pyramid. The technique is not advocated when hump resection is performed, as it is unnecessary and could destabilize the dorsum. Even aggressive maneuvers to mobilize the bony dorsum may fail if not performed properly with meticulous attention to completion of all osteotomies.
当试图矫正患者愈合的、偏斜的鼻背骨时，在内侧和外侧截骨完成后，必须处理中央结构（高鼻中隔和鼻内侧骨）的偏斜。当不进行驼峰切除时，对偏斜的中央结构进行钝性骨折（用手指或镊子）不是一种可靠的松动方法，常常导致术后鼻背偏移。本文描述了一种用于松动鼻中央结构的鼻内截骨技术，称为“高位鼻中隔截骨术”。对25例病例的回顾表明，高位鼻中隔截骨术在必要时辅以重叠鼻中隔成分切除术，可以安全有效地进行，使鼻锥体稳定地向中线复位。当进行驼峰切除时不提倡使用该技术，因为这是不必要的，且可能使鼻背不稳定。如果不仔细完成所有截骨操作，即使是积极的鼻背松动操作也可能失败。
