Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, University of Virginia, Charlottesville, VA, USA.
Clin Exp Otorhinolaryngol. 2011 Jun;4(2):55-66. doi: 10.3342/ceo.2011.4.2.55. Epub 2011 May 31.
This review article will highlight several fundamental principles and advances in rhinoplasty. Nasal analysis has become more sophisticated and thorough in terms of breaking down the anomaly and identifying the anatomic etiology. Performing this analysis in a systematic manner each time helps refine these skills and is a prerequisite to sound surgical planning. Dorsal augmentation with alloplastic materials continue to be used but more conservatively and often mixed with autogenous grafts. Long term outcomes have also taught us much with regards to wound healing and soft tissue contracture. This is best demonstrated with a hump reduction where the progressive pinching at the middle vault creates both aesthetic and functional problems. Correcting the twisted nose is challenging and requires a more aggressive intervention than previously thought. Both cartilage and soft tissue appear to have a degree of memory that predispose to recurrent deviations. A complete structural breakdown and destabilization may be warranted before the nose is realigned. This must be followed by careful and meticulous restabilization. Tip refinement is a common request but no single maneuver can be universally applied; multiple techniques and grafts must be within the surgeon's armamentarium.
这篇综述文章将重点介绍鼻整形术的几个基本原则和进展。鼻分析在分解异常和确定解剖病因方面变得更加复杂和彻底。每次以系统的方式进行这种分析有助于完善这些技能，是合理手术规划的前提。使用同种异体材料进行鼻背增高仍在使用，但更为保守，通常与自体移植物混合使用。长期结果也让我们了解了伤口愈合和软组织挛缩的很多问题。驼峰减少术就是一个很好的例子，在该手术中，中隔穹窿的逐渐变窄会导致美学和功能问题。矫正扭曲的鼻子具有挑战性，需要比以前认为的更积极的干预。软骨和软组织似乎都有一定的记忆，容易导致复发的偏曲。在重新对线之前，可能需要完全结构性的破坏和稳定。这之后必须进行仔细和精心的重新稳定。鼻尖细化是常见的要求，但没有单一的操作可以普遍应用；必须在外科医生的武器库中使用多种技术和移植物。
