Bloom Jason D, Sridharan Shaum, Hagiwara Mari, Babb James S, White W Matthew, Constantinides Minas
Main Line Center for Laser Surgery, Ardmore, Pennsylvania 19003, USA.
Arch Facial Plast Surg. 2012 Sep-Oct;14(5):331-5. doi: 10.1001/archfacial.2012.50.
To assess the cross-sectional area and angle of the internal nasal valve more accurately by reformatting computed tomography (CT) scans of the nasal airway according to a more appropriate orientation than scans traditionally sectioned in the coronal plane and then to compare the results with clinical data on the nasal valve obtained from physical examination.
We performed a retrospective review of the medical records of 24 rhinoplasty patients treated at a private practice facial plastic surgery office affiliated with a tertiary care university hospital. The patients had fine-cut (0.75-mm section) CT scans ordered for nasal airway obstruction or nasal valve compromise at the same institution. These patients were evaluated from January 1, 2000, through December 31, 2010. The previously acquired CT scans were reformatted to obtain sections through the internal nasal valve at a more appropriate orientation. The internal nasal valve cross-sectional area and valve angle were measured through a standardized section (1 cut immediately anterior to the head of the inferior turbinate) from the reformatted scans. The cross-sectional area was also measured through the same point on the traditionally oriented CT scan, and the values were compared. The results from each patient's scan were compared with data from the patient's medical record and analyzed against the patient's preoperative modified Cottle examination findings.
The CT scans oriented in the reformatted plane through the internal nasal valve provided a narrower valve angle than the traditionally oriented CT scans and more closely approximated the hypothesized true value of the internal nasal valve of 10° to 15° (P < .001). In a comparison of the same-side internal nasal valve angle and cross-sectional nasal valve area between the 2 different CT scan orientations, a statistically significant difference in the internal nasal valve angles between the 2 scan orientations was discovered, but this finding did not reach significance when distinguishing the nasal valve cross-sectional area. Finally, no correlation was found with regard to the preoperative modified Cottle maneuver scores for the internal nasal valve angle and cross-sectional valve area values in either scan orientation.
Precise preoperative evaluation of the internal nasal valve is critical to the workup for reconstruction or repair of problems that involve this area. Although tools such as acoustic rhinometry exist to evaluate the cross-sectional area of the nasal valve, many rhinoplasty surgeons do not have access to this expensive equipment. A CT scan with reformatting in the proper plane of the internal nasal valve can provide the surgeon with improved anatomical information to assess that region. With this in mind, however, the surgeon should always perform a thorough preoperative physical examination and treat the patient and his or her symptoms, not the imaging studies, when considering a candidate for a surgical intervention.
通过按照比传统冠状面扫描更合适的方向重新格式化鼻气道的计算机断层扫描（CT），更准确地评估鼻内阀的横截面积和角度，然后将结果与通过体格检查获得的鼻阀临床数据进行比较。
我们对一家隶属于三级大学医院的私人面部整形手术诊所治疗的24例隆鼻患者的病历进行了回顾性研究。这些患者在同一机构因鼻气道阻塞或鼻阀受损接受了薄层（0.75毫米层厚）CT扫描。这些患者于2000年1月1日至2010年12月31日期间接受评估。将先前获取的CT扫描重新格式化，以在更合适的方向获得通过鼻内阀的层面。通过重新格式化扫描的标准化层面（在下鼻甲头部前方紧邻的1个层面）测量鼻内阀横截面积和阀角。还通过传统方向的CT扫描上的同一点测量横截面积，并比较测量值。将每位患者扫描的结果与患者病历中的数据进行比较，并根据患者术前改良科特尔检查结果进行分析。
通过重新格式化平面的鼻内阀CT扫描显示的阀角比传统方向的CT扫描窄，且更接近鼻内阀假设的真实值10°至15°（P <.001）。在比较两种不同CT扫描方向同侧的鼻内阀角度和鼻阀横截面积时，发现两种扫描方向的鼻内阀角度存在统计学显著差异，但在区分鼻阀横截面积时，这一差异未达到显著水平。最后，在两种扫描方向上，鼻内阀角度和阀横截面积值与术前改良科特尔手法评分均未发现相关性。
鼻内阀的精确术前评估对于涉及该区域的重建或修复问题的检查至关重要。尽管存在如鼻声反射仪等工具来评估鼻阀的横截面积，但许多隆鼻外科医生无法使用这种昂贵的设备。在鼻内阀的适当平面进行重新格式化的CT扫描可为外科医生提供更好的解剖信息以评估该区域。然而，考虑到这一点，外科医生在考虑手术干预候选人时，应始终进行全面的术前体格检查，并治疗患者及其症状，而不是仅仅依据影像学检查结果。
