Palma Pietro, Khodaei Iman
aDepartment of Otorhinolaringology Head & Neck Surgery, University Hospital, Varese, Italy bMehregan Clinic, Karaj, Iran.
Curr Opin Otolaryngol Head Neck Surg. 2014 Feb;22(1):52-7. doi: 10.1097/MOO.0000000000000019.
This article reviews the current trends in the surgical approach to the caudal septum, and its importance in rhinoplasty. The evolution of rhinoplasty techniques over the past half century has changed the emphasis from excessive cartilage resection, and a plethora of grafts and sutures, to a more conservative approach that seeks to maintain the function of the nose and create a naturally beautiful, 'not-operated' look.
New anatomical studies continue to shed light on the importance of soft-tissue support, and the mechanical properties of the caudal septum. When applied to surgical techniques, these new findings emphasize the principles of adequate preoperative history and examination, nasendoscopy, and facial analysis. On the basis of these clinical findings, a unique, tailor-made rhinoplasty game plan can be created for each patient that should not be used for another operation. Several techniques have emerged from the natural evolution of rhinoplasty that produce controlled, reversible effects in a predictable, stepwise manner.
The caudal septum plays a key role in nasal airflow, provides support for the nasal tip, and affects the alar-columellar relationship. Deviation at the caudal septum creates some of the commonest problems in aesthetic rhinoplasty.Through new anatomical knowledge and advances in rhinoplasty techniques, the vast majority of these problems can be approached through an endonasal/hybrid rhinoplasty approach. Hybrid rhinoplasty refers to a distillation of best of both worlds of external and endonasal surgery over the past 40 years.The key to a successful outcome relies on adequate clinical examination, nasendoscopy, detailed surgical facial analysis, and a well planned surgical game plan.
SDC 1 (http://links.lww.com/COOH/A9).
本文回顾了鼻尾中隔手术方法的当前趋势及其在鼻整形术中的重要性。在过去半个世纪中，鼻整形技术的发展已将重点从过度切除软骨、大量使用移植物和缝线，转变为更保守的方法，该方法旨在维持鼻子的功能并营造自然美观、“未动过手术”的外观。
新的解剖学研究不断揭示软组织支撑以及鼻尾中隔力学特性的重要性。将这些新发现应用于手术技术时，强调了充分的术前病史和检查、鼻内镜检查以及面部分析的原则。基于这些临床发现，可以为每位患者制定独特的、量身定制的鼻整形手术方案，且该方案不应适用于其他手术。鼻整形术的自然发展产生了几种技术，这些技术以可预测的、逐步的方式产生可控的、可逆的效果。
鼻尾中隔在鼻气流中起关键作用，为鼻尖提供支撑，并影响鼻翼 - 鼻小柱关系。鼻尾中隔偏斜会导致美容性鼻整形术中一些最常见的问题。通过新的解剖学知识和鼻整形技术的进步，绝大多数这些问题可通过鼻内/联合鼻整形术方法解决。联合鼻整形术是过去40年中外鼻手术和鼻内手术两者优点的融合。成功结果的关键在于充分的临床检查、鼻内镜检查、详细的手术面部分析以及精心规划的手术方案。
