Margulis Alexander, Harel Marcos
Department of Plastic Surgery, Hadassah Medical Center of Hebrew University, P.O. Box 12000, Kiryat Hadassah, Jerusalem, Israel.
J Plast Reconstr Aesthet Surg. 2007;60(4):400-6. doi: 10.1016/j.bjps.2006.10.013. Epub 2006 Dec 29.
Tip ptosis is a relatively common nasal deformity, with an incidence as high as 72% in rhinoplasty patients. Different techniques were described for surgical correction of the droopy tip, such as the lateral crural steel, the lateral crural overlay, the tongue-in-groove technique and others. Most authors agreed that an external rhinoplasty approach is necessary for effectively conducting the alar cartilage-modifying techniques mentioned above.
In this article we challenge this paradigm and introduce an efficient method for aesthetic correction of severe tip ptosis through an internal rhinoplasty approach. Twenty-three patients with severe ptosis of the nasal tip were operated on by the senior author (MH) between 2000 and 2005 using the described technique. After carrying out the necessary manoeuvres to achieve the desired tip rotation (reduction of cephalic border of alar cartilages, modification of the caudal septum, reduction of upper lateral cartilages), the desired tip position was maintained with the horizontal columellar strut, whose initial operative description appears here.
The desired rotation and projection were maintained in all but three patients over the first year after the surgery. In three patients we observed some loss of tip projection after 1 year. We did not witness complications directly related to the horizontal columellar strut.
The horizontal columellar strut is an efficient tool for stabilising the corrected position of a severely ptotic nasal tip. We recommend adding the horizontal columellar strut to the array of available rhinoplasty techniques.
鼻尖下垂是一种较为常见的鼻部畸形，在隆鼻患者中的发生率高达72%。针对下垂鼻尖的手术矫正描述了不同的技术，如外侧脚支撑、外侧脚覆盖、榫槽技术等。大多数作者认为，采用鼻外入路对于有效实施上述鼻翼软骨矫正技术是必要的。
在本文中，我们对这一范例提出挑战，并介绍一种通过鼻内入路对严重鼻尖下垂进行美学矫正的有效方法。2000年至2005年间，资深作者（MH）使用所述技术为23例严重鼻尖下垂患者进行了手术。在进行必要的操作以实现所需的鼻尖旋转（降低鼻翼软骨的头侧边缘、修整鼻中隔尾侧、减少上外侧软骨）后，使用水平鼻小柱支撑来维持所需的鼻尖位置，此处首次描述其手术操作。
除3例患者外，所有患者在术后第一年都维持了所需的旋转和突出度。3例患者在1年后出现了一些鼻尖突出度的丧失。我们未观察到与水平鼻小柱支撑直接相关的并发症。
水平鼻小柱支撑是稳定严重下垂鼻尖矫正位置的有效工具。我们建议将水平鼻小柱支撑添加到现有的隆鼻技术中。
