Ghanaatpisheh Mohammad, Sajjadian Ali, Daniel Rollin K
Dr Ghanaatpisheh is a plastic surgeon in private practice in Tehran, Iran. Drs Sajjadian and Daniel are plastic surgeons in private practice in Newport Beach, CA.
Aesthet Surg J. 2015 Jan;35(1):28-39. doi: 10.1093/asj/sju013.
Although frequently performed in rhinoplasty, nasal osteotomies have been unpredictable in consistently controlling postoperative alterations in bony morphology in many patients. Consequently, a detailed algorithm for an individualized approach to osteotomy is needed to achieve superior aesthetic and functional outcomes.
The authors aimed to propose a component-oriented and individualized approach for nasal osteotomy in rhinoplasty.
Clinical outcomes were reviewed for 150 consecutive patients who underwent rhinoplasty. Type and frequency of specific osteotomy procedures and preoperative and postoperative photographs were examined.
A total of 97 cases with at least 12 months of follow-up data were evaluated. In 92 of 97 patients (95%), a lateralized medial oblique osteotomy was performed; 70 (72%) required bilateral intermediate osteotomy, and 21 (22%) required unilateral osteotomy. Forty-one patients (42%) underwent bilateral base osteotomy and 24 (25%) underwent unilateral base osteotomy. No base osteotomy was performed in 32 patients (33%) who had aesthetically pleasing lateral wall width and no convexity of the posterior portion of the lateral bony wall.
The osteocartilaginous vault is asymmetric in the majority of patients undergoing rhinoplasty. Anatomic variations in the height, length, and/or width of the bony vault can significantly influence its shape and symmetry. Various principles and techniques for nasal osteotomy increase predictability of outcomes while improving nasal aesthetics and function. LEVEL OF EVIDENCE 4: Therapeutic.
尽管鼻骨截骨术在鼻整形术中经常进行，但在许多患者中，它在持续控制术后骨形态改变方面一直难以预测。因此，需要一种详细的个体化截骨术算法，以实现更好的美学和功能效果。
作者旨在提出一种面向组件的个体化鼻整形术中鼻骨截骨术方法。
回顾了150例连续接受鼻整形术患者的临床结果。检查了特定截骨手术的类型和频率以及术前和术后照片。
共评估了97例至少有12个月随访数据的病例。97例患者中有92例（95%）进行了外侧化内侧斜行截骨术；70例（72%）需要双侧中间截骨术，21例（22%）需要单侧截骨术。41例患者（42%）接受了双侧基底截骨术，24例（25%）接受了单侧基底截骨术。32例（33%）患者的外侧壁宽度美观且外侧骨壁后部无凸起，未进行基底截骨术。
在大多数接受鼻整形术的患者中，骨软骨穹窿是不对称的。骨穹窿高度、长度和/或宽度的解剖变异可显著影响其形状和对称性。各种鼻骨截骨术的原则和技术提高了结果的可预测性，同时改善了鼻美学和功能。证据级别4：治疗性。
