Dallas, Texas From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.
Plast Reconstr Surg. 2014 Mar;133(3):509-518. doi: 10.1097/01.prs.0000438453.29980.36.
Dorsal hump reduction can lead to significant aesthetic and functional deformities if one does not preserve and subsequently restore proper position of the upper lateral cartilages. The senior author (R.J.R.) previously described the component dorsal hump reduction to preserve the integrity of the upper lateral cartilages, thereby avoiding routine use of spreader grafts. In this study, the authors introduce their algorithm for reconstitution of the nasal dorsum.
The charts of 100 consecutive primary rhinoplasty patients from the senior author's practice were reviewed. The technique used for dorsal reconstitution, complications, and revisions were analyzed. Preoperative and postoperative images of the dorsal aesthetic lines were examined for symmetry and contour.
Mean follow-up was 19 months. A dorsal hump reduction of 5 mm or more was performed in 39 patients (39 percent). No patients received spreader grafts. The technique used for dorsum reconstitution was upper lateral cartilage tension spanning suture (type 1) in 65 percent, reapproximation (type 2) in 25 percent, and spreader flaps (type 3) in 10 percent. There were no significant complications and 4 percent required revision. Dorsal aesthetic lines were symmetric in 69 patients (69 percent) preoperatively and in 94 patients (94 percent) postoperatively. The authors found 65 dorsal aesthetic lines (32.5 percent) without contour irregularities preoperatively compared with 194 (97 percent) postoperatively.
Reconstituting the nasal dorsum with repositioning of the upper lateral cartilages that is based on the individual anatomy of the rhinoplasty patient can provide durable cosmetic and functional results without the need for routine use of spreader grafts.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
如果不保留上外侧软骨并随后恢复其适当位置，进行驼峰减少术可能会导致明显的美学和功能畸形。资深作者（R.J.R.）曾描述过一种驼峰减少术的组成部分，以保留上外侧软骨的完整性，从而避免常规使用撑开移植物。在这项研究中，作者介绍了他们重建鼻背的算法。
回顾了资深作者实践中连续 100 例原发性鼻整形术患者的图表。分析了用于重建鼻背的技术、并发症和修复。检查了术前和术后的背侧美学线图像，以评估对称性和轮廓。
平均随访时间为 19 个月。39 例患者（39%）行驼峰减少术，减少 5 毫米或以上。无患者接受撑开移植物。用于重建背侧的技术是上外侧软骨张力跨越缝线（1 型）占 65%，重新接近（2 型）占 25%，撑开皮瓣（3 型）占 10%。无明显并发症，4%需要修复。69 例患者（69%）术前背侧美学线对称，94 例患者（94%）术后对称。作者发现术前有 65 条背侧美学线（32.5%）无轮廓不规则，术后有 194 条（97%）无轮廓不规则。
根据鼻整形患者的个体解剖结构，通过重新定位上外侧软骨来重建鼻背，可以提供持久的美容和功能效果，而无需常规使用撑开移植物。
临床问题/证据水平：治疗，IV。
