Jung Dong Hak, Kim Bum Ryul, Choi Ji Yoon, Rho Young Soo, Park Hyo Jin, Han Wade W
Seoul, South Korea; and Orlando, Fla. From the Simmian Aesthetic Clinic and Division of Facial Plastic and Reconstructive Surgery, Department of Otorhinolaryngology, Kangdong Sacred Heart Hospital, Hallym University School of Medicine, and Florida Ear, Nose, and Throat and Facial Plastic Surgery.
Plast Reconstr Surg. 2007 Dec;120(7):1997-2003. doi: 10.1097/01.prs.0000287323.71630.e6.
In augmentation rhinoplasty, delayed morphologic changes are often observed with silicone implants, despite them being known as a safe implant material. The purpose of this study was to identify the cause and time course of delayed shape changes of silicone implants, through the long-term evaluation of inserted implants and their surrounding nasal soft tissues after their removal at revision rhinoplasty operations.
Two hundred twenty-one silicone implants removed during revision rhinoplasty were studied. The period of insertion ranged from 1 month to 25 years, with an average of 6 years 7 months. Calcification within the silicone implants and, when available, the capsular soft-tissue attachments were examined with the naked eye and light microscopy.
Calcification was first observed grossly with the naked eye after 5 years 8 months of insertion. With light microscopy, calcification debris could be seen after 4 years. After implant insertion for more than 9 years, focal calcification could be seen in 50 percent of implants. When implants had been inserted for more than 15 years, a denatured type of large calcification was clearly observed. Plasma cell, macrophage, and neutrophil proliferation was noted in the soft-tissue capsule surrounding the superficial calcifications in those individuals with an early inflammatory response, and lymphocyte proliferation was noted in those with a late inflammatory response.
Silicone implants were noted to induce calcification when inserted for a long time, causing long-term morphologic changes. This should be taken into consideration when choosing silicone implants for augmentation rhinoplasty.
在隆鼻术中，尽管硅胶植入物被认为是一种安全的植入材料，但经常观察到其存在延迟的形态变化。本研究的目的是通过对隆鼻修复手术中取出的植入物及其周围鼻软组织进行长期评估，确定硅胶植入物延迟形状变化的原因和时间进程。
对隆鼻修复手术中取出的221个硅胶植入物进行研究。植入时间从1个月到25年不等，平均为6年7个月。对硅胶植入物内的钙化以及（如有）包膜软组织附着物进行肉眼和光学显微镜检查。
植入5年8个月后首次通过肉眼观察到钙化。在光学显微镜下，4年后可见钙化碎片。植入超过9年后，50%的植入物中可见局灶性钙化。植入超过15年后，明显观察到一种变性的大钙化。在早期炎症反应患者中，浅表钙化周围的软组织包膜中可见浆细胞、巨噬细胞和中性粒细胞增殖，在晚期炎症反应患者中可见淋巴细胞增殖。
硅胶植入物长时间植入后会诱导钙化，导致长期形态变化。在选择硅胶植入物进行隆鼻术时应考虑到这一点。
