Jung Dong-Hak, Chang Geun-Uck, Shan Lei, Liu Da-Lie, Wang Zhi-Jun, Tian Hong-Jun, Chen Can, Han Wade W
Shimmian Rhinoplasty Clinic, 211, Seocho Hyundai Tower, 1319-13, Seocho-dong, Seochu-gu, Seoul 137-070, South Korea.
Arch Facial Plast Surg. 2010 Jul-Aug;12(4):257-62. doi: 10.1001/archfacial.2010.44.
To investigate septal cartilage compressive changes as a result of bilateral extended spreader grafts (ESGs), which are commonly used in rhinoplasty. The buckling, rupturing, or necrosis of the recipient site leads to nasal tip structural deformity. These pathologic changes associated with bilateral ESGs warrant the clinician's attention and in-depth basic and clinical research.
The basic experimental study involves New Zealand rabbits, randomly assigned to groups A, B, C, and D, with group A as a reference. The right auricular cartilage was harvested and transplanted into a corresponding anatomic location of the left ear. The compressive effect was studied by gross observation and microscopic examination with hematoxylin-eosin staining after 3 months. In a clinical experiment, revision rhinoplasty surgical procedures were performed in 10 human patients 6 months to 1 year after placement of bilateral ESGs. The compressive changes of septal cartilages between the ESGs were observed intraoperatively.
In group A of the rabbits, no pathologic change was noted, but 2 cases of attenuation were observed in group B (33.3%), 6 cases of central fracture (100%) with 1 case of perforation (16.7%) in group C, and 6 cases of different degrees of defects in group D (100%). Clinical intraoperative observations revealed 1 case of defects and necrosis (10%), 4 cases of attenuations and cracks (40%), and 5 cases of attenuations (50%).
Septal cartilage compressive necrosis leading to structural damage by bilateral septal ESGs is a clinically significant complication of rhinoplasty. Owing to its affect on the viability of the original septal cartilages, we believe the unilateral ESG with columellar strut is preferred, especially in Asian patients.
研究鼻中隔软骨在双侧扩展撑开移植片（ESGs）作用下的压缩变化，双侧扩展撑开移植片常用于鼻整形术。受体部位的屈曲、破裂或坏死会导致鼻尖结构畸形。这些与双侧ESGs相关的病理变化值得临床医生关注并进行深入的基础和临床研究。
基础实验研究使用新西兰兔，随机分为A、B、C、D组，A组作为参照。切取右侧耳廓软骨并移植到左耳相应解剖位置。3个月后通过大体观察和苏木精-伊红染色的显微镜检查研究压缩效果。在一项临床实验中，对10例双侧ESGs植入6个月至1年的患者进行鼻整形修复手术。术中观察ESGs之间鼻中隔软骨的压缩变化。
兔A组未观察到病理变化，但B组观察到2例萎缩（33.3%），C组有6例中央骨折（100%），其中1例穿孔（16.7%），D组有6例不同程度的缺损（100%）。临床术中观察发现1例缺损和坏死（10%），4例萎缩和裂纹（40%），5例萎缩（50%）。
双侧鼻中隔ESGs导致鼻中隔软骨压缩性坏死并造成结构损伤是鼻整形术中具有临床意义的并发症。鉴于其对原鼻中隔软骨活力的影响，我们认为带鼻小柱支撑的单侧ESG更可取，尤其是在亚洲患者中。
