Reitzen Shari D, Morris Luc G T, Davis Richard E
Department of Surgery, Memorial Hospital, Miramar, FL 33029, USA.
Arch Facial Plast Surg. 2011 Sep-Oct;13(5):311-5. doi: 10.1001/archfacial.2011.56.
To objectively determine the prevalence of occult nasal base asymmetry in adults with wide nasal tips using a standard photographic editing program.
We performed a retrospective observational study in a private practice, ambulatory care setting. The photographs of 100 randomly selected patients undergoing rhinoplasty who presented with excessive nasal tip width and no apparent nasal base asymmetry were evaluated for occult nostril asymmetry. Patients varied by ethnicity and sex and ranged in age from 16 to 40 years. We excluded patients with discrete nasal base asymmetry, crooked or twisted noses, caudal septal deviation, columellar tilt, a history of craniofacial trauma, or a history of nasal surgery. Measurements were obtained using a standard photographic analysis program.
On the basal view, the median percentage of asymmetry (95% confidence interval) was 4.91% (4.17%-5.66%); on the frontal view, 4.66% (3.68%-5.62%). On the basal view, 73% of noses were at least 2.5% asymmetric; on the frontal view, 67% (McNemar P = .53). On the basal view, 48% of noses were at least 5% asymmetric; on the frontal view, 50% (McNemar P = .74). On the basal view, 11% of noses were at least 10% asymmetric; on the frontal view, 20% (McNemar P = .11).
A large percentage of individuals presenting with excessive nasal tip width and no obvious alar size discrepancies have nasal base asymmetry. Moreover, nostril asymmetry is demonstrated from the frontal and basal views with reasonable consistency. In a small subset of study patients, occult nostril asymmetry exceeded 10% of the total nasal base width. We postulate that clinically significant nostril size discrepancies are hidden by excessive tip width, and we speculate that these nostril size discrepancies become more apparent after surgical refinement of the oversized nasal tip, thereby potentially leading to unexpected postoperative cosmetic imperfections and patient dissatisfaction. The apparent frequency of (occult) nostril asymmetry in patients with excessive nasal tip width underscores the importance of nostril size assessment in the preoperative aesthetic analysis. We offer a reliable and convenient method for objective analysis of nasal base symmetry.
使用标准的照片编辑程序客观地确定宽鼻尖成年人隐匿性鼻基底不对称的患病率。
我们在一家私人门诊护理机构进行了一项回顾性观察研究。对100例随机选择的接受鼻整形手术的患者照片进行评估，这些患者鼻尖宽度过大且无明显鼻基底不对称，以确定隐匿性鼻孔不对称情况。患者的种族、性别各异，年龄在16至40岁之间。我们排除了存在明显鼻基底不对称、鼻子弯曲或扭曲、鼻中隔尾端偏曲、鼻小柱倾斜、有颅面外伤史或鼻部手术史的患者。使用标准的照片分析程序进行测量。
在基底视图上，不对称的中位数百分比（95%置信区间）为4.91%（4.17%-5.66%）；在正面视图上为4.66%（3.68%-5.62%）。在基底视图上，73%的鼻子至少有2.5%的不对称；在正面视图上为67%（麦克内马尔检验P = 0.53）。在基底视图上，48%的鼻子至少有5%的不对称；在正面视图上为50%（麦克内马尔检验P = 0.74）。在基底视图上，11%的鼻子至少有10%的不对称；在正面视图上为20%（麦克内马尔检验P = 0.11）。
很大一部分鼻尖宽度过大且鼻翼大小无明显差异的个体存在鼻基底不对称。此外，从正面和基底视图来看，鼻孔不对称具有合理的一致性。在一小部分研究患者中，隐匿性鼻孔不对称超过了鼻基底总宽度的10%。我们推测临床上显著的鼻孔大小差异被过大的鼻尖宽度所掩盖，并且我们推测在对过大的鼻尖进行手术修整后，这些鼻孔大小差异会变得更加明显，从而可能导致意想不到的术后美容缺陷和患者不满。鼻尖宽度过大的患者中（隐匿性）鼻孔不对称的明显频率强调了在术前美学分析中评估鼻孔大小的重要性。我们提供了一种可靠且方便的方法来客观分析鼻基底对称性。
