Tellioğlu Ali Teoman, Özakpinar Hülda Rifat, Cakir Bariş, Tekdemir Ibrahim
Department of Plastic, Reconstructive and Aesthetic Surgery, Diskapi Yildirim Beyazit Education and Research Hospital, and Department of Anatomy, Medical School of Ankara University, Ankara, Turkey.
J Craniofac Surg. 2011 Mar;22(2):446-9. doi: 10.1097/SCS.0b013e3182077ae5.
Deviated cartilages structures of the nose can be affected by nasal muscles, and deviation becomes conspicuous when the patient smiles. This condition depends on activity of nasal muscles, particularly the levator labii alaeque nasi muscle. A total of 124 septorhinoplasty operations were performed to correct dorsal concave septal deviation between 2005 and 2009 years. The 70 women and 54 men included in the study had an average age of 28 years. The average follow-up period was 12 months. Open septorhinoplasty was preferred in all cases. The medial part of the levator labii alaeque nasi muscle was extensively dissected from the lateral crus and surrounding tissues. The lateral crura of the alar cartilages were separated from the upper lateral cartilages in the scroll area. The dorsal septal deviation was corrected by combination of bilateral spreader grafts, which reinforced cartilage with horizontal control sutures. Early postoperative period was uneventful. Nasal obstruction was reduced after surgery, and significant subjective postoperative improvements were observed in all patients. Comparison of preoperative and postoperative photographs demonstrated improved dorsal nasal contour. Revision operation was performed in 3 cases. The corrected septal cartilage was in a good position in all revised cases; therefore, septal surgery was not performed in the revision operations. In conclusion, surgical disruption of the anatomic relationship between the muscle with the dorsal septal cartilage and reinforcement of the dorsal septal cartilage with spreader grafts and horizontal control sutures can decrease risk of recurrence.
鼻中隔软骨结构的偏斜可能会受到鼻部肌肉的影响，当患者微笑时偏斜会变得明显。这种情况取决于鼻部肌肉的活动，尤其是提上唇鼻翼肌。2005年至2009年期间，共进行了124例鼻中隔鼻成形术以纠正鼻中隔背侧凹陷性偏斜。纳入研究的70名女性和54名男性平均年龄为28岁。平均随访期为12个月。所有病例均首选开放式鼻中隔鼻成形术。提上唇鼻翼肌的内侧部分从外侧脚和周围组织广泛分离。鼻翼软骨的外侧脚在鼻阀区与上外侧软骨分离。通过双侧撑开移植联合水平控制缝线加强软骨来纠正鼻中隔背侧偏斜。术后早期情况平稳。术后鼻塞减轻，所有患者术后主观上均有明显改善。术前和术后照片对比显示鼻背轮廓改善。3例患者进行了翻修手术。在所有翻修病例中，矫正后的鼻中隔软骨位置良好；因此，翻修手术中未进行鼻中隔手术。总之，破坏肌肉与鼻中隔背侧软骨之间的解剖关系，并通过撑开移植和水平控制缝线加强鼻中隔背侧软骨，可以降低复发风险。
