Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology, New York University, New York, New York 10016, USA.
JAMA Facial Plast Surg. 2013 Jul-Aug;15(4):268-74. doi: 10.1001/jamafacial.2013.151.
The effect of different rhinoplasty maneuvers on alar retraction remains to be elucidated.
To determine the etiology and treatment of alar retraction based on a series of specific rhinoplasty maneuvers.
Retrospective review of a single surgeon's rhinoplasty digital photo database, examining preoperative alar retraction from January 1, 2002, to December 31, 2005, in 520 patients. Patients with more than 1 mm of alar retraction on preoperative photographs were identified. Postoperative photographs were examined to determine the effect of specific rhinoplasty maneuvers on the position of the alar margin; these maneuvers included cephalic trim, cephalic positioning of the lower lateral cartilage, composite grafts, alar rim grafts, alar batten grafts, and overlay of the lower lateral cartilage.
Tertiary care academic health center.
Forty-five patients with alar retraction met inclusion criteria, resulting in 63 nasal halves with alar retraction.
Intraoperative findings, postoperative results.
Forty-seven percent of the patients (n = 21) had prior surgery; 47% also had cephalically positioned lower lateral cartilages. Among patients with less than 4 mm of cartilage width at the outset, 46% of those who received supportive grafts achieved target correction vs only 7% for patients who did not undergo supportive cartilage grafting. In patients who underwent more than 4 mm of cephalic trim, those who received supportive grafts achieved 46% of target correction vs 11% among those who did not. Ninety-five percent of composite grafts, 69% of alar strut grafts, 47% of alar rim grafts, 43% of vertical lobule division, and 12% of alar batten grafts achieved their target correction values.
Alar retraction is a highly complex problem. It can be seen de novo and is associated with cephalically positioned lower lateral cartilages. Structurally supportive grafting-including composite grafts, alar strut grafts, alar rim grafts, vertical lobule division, and alar batten grafts-can improve alar retraction.
不同鼻整形术操作对鼻翼退缩的影响仍有待阐明。
基于一系列特定的鼻整形术操作，确定鼻翼退缩的病因和治疗方法。
回顾性分析一位外科医生的鼻整形术数码照片数据库，检查 2002 年 1 月 1 日至 2005 年 12 月 31 日期间 520 例患者的术前鼻翼退缩情况。确定术前照片上鼻翼退缩超过 1 毫米的患者。检查术后照片，以确定特定鼻整形术操作对鼻翼缘位置的影响；这些操作包括头侧修剪、下外侧软骨的头侧定位、复合移植物、鼻翼缘移植物、鼻翼板条移植物和下外侧软骨的覆盖。
三级保健学术中心。
45 例鼻翼退缩患者符合纳入标准，63 个鼻翼退缩的鼻半侧符合研究要求。
术中发现，术后结果。
47%的患者（n=21）曾接受过手术；47%的患者也有头侧定位的下外侧软骨。在起始时软骨宽度小于 4 毫米的患者中，接受支撑性移植物的患者中有 46%达到了目标矫正，而未接受支撑性软骨移植的患者中只有 7%达到了目标矫正。在接受头侧修剪超过 4 毫米的患者中，接受支撑性移植物的患者中有 46%达到了目标矫正，而未接受支撑性移植物的患者中只有 11%达到了目标矫正。95%的复合移植物、69%的鼻翼支撑移植物、47%的鼻翼缘移植物、43%的垂直小叶分离和 12%的鼻翼板条移植物达到了目标矫正值。
鼻翼退缩是一个高度复杂的问题。它可以是新发的，与头侧定位的下外侧软骨有关。结构支撑性移植术——包括复合移植物、鼻翼支撑移植物、鼻翼缘移植物、垂直小叶分离和鼻翼板条移植物——可以改善鼻翼退缩。
4 级。
