Tezel Erdem, Ersoy Burak
From the *Department of Plastic, Reconstructive and Aesthetic Surgery, Marmara University School of Medicine; and †Department of Plastic, Reconstructive and Aesthetic Surgery, Maltepe University School of Medicine, Istanbul, Turkey.
Ann Plast Surg. 2016 Sep;77(3):264-71. doi: 10.1097/SAP.0000000000000410.
A beautiful and appealing nose receives the greatest contribution from the nasal tip subunit, which should be regarded as the primary center of attention during a rhinoplasty procedure. In achieving the desired shape and position of the nasal tip during closed rhinoplasty, the septocolumellar suture functions as the major determinant together with the caudal portion of the septal cartilage, which has a significant influence on the versatility of the septocolumellar suture. The purpose of this study was to present the analysis of the indications, the technical steps, and the advantages of caudal septal graft and septocolumellar suture utilization in closed rhinoplasty.
The septocolumellar suture with or without the caudal septal graft combination procedure has been performed in 2286 patients via a closed rhinoplasty approach. Intraoperatively, the septal cartilage at hand was thoroughly evaluated and one of the 5 types of caudal septal grafts was used when necessary. After the establishment of a strong and straight septal cartilage with sufficient height and length, 4 different septocolumellar sutures in a specific order were used to modify the relationship between the lower lateral cartilages and the nasal septum.
Of the 2286 cases, 1837 (80.3%) were primary and 449 (19.7%) secondary rhinoplasties, which have been followed up for 9 to 48 months. The caudal septal graft was combined to the septocolumellar suture in 621 (27.1%) patients. Of the caudal septal grafts, 69.7% were used for primary rhinoplasty cases, and 30.3% for secondary rhinoplasties. At the 18th month postoperatively, tip projection was found to be satisfactory for 98% of the patients.
The septocolumellar suture combined with caudal septal graft in closed rhinoplasty substantially facilitates the achievement of a cosmetically and functionally pleasing end result, bringing the solution for a wide array of problems such as short nose, supratip deformity, nasolabial angle change, or columellar bowing. Nevertheless, the technique has a steep learning curve; therefore, a meticulous preoperative evaluation should be exerted, a precise surgical planning should be prosecuted, and an excessive reduction of the nasal tip or exaggerated columellar retraction should be avoided.
一个美观且吸引人的鼻子，鼻尖亚单位的贡献最大，在鼻整形手术过程中，鼻尖亚单位应被视为主要关注点。在闭合式鼻整形术中，为实现理想的鼻尖形状和位置，鼻中隔-鼻小柱缝合与鼻中隔软骨的尾侧部分共同作为主要决定因素，鼻中隔软骨的尾侧部分对鼻中隔-鼻小柱缝合的多样性有显著影响。本研究的目的是分析闭合式鼻整形术中尾侧鼻中隔移植和鼻中隔-鼻小柱缝合应用的适应证、技术步骤及优势。
通过闭合式鼻整形方法，对2286例患者实施了鼻中隔-鼻小柱缝合联合或不联合尾侧鼻中隔移植的手术。术中，对现有的鼻中隔软骨进行全面评估，必要时使用5种尾侧鼻中隔移植类型中的一种。在建立具有足够高度和长度的坚固且笔直的鼻中隔软骨后，按特定顺序使用4种不同的鼻中隔-鼻小柱缝合来调整下外侧软骨与鼻中隔之间的关系。
2286例患者中，1837例（80.3%）为初次鼻整形，449例（19.7%）为二次鼻整形，随访时间为9至48个月。621例（27.1%）患者的尾侧鼻中隔移植与鼻中隔-鼻小柱缝合联合使用。在尾侧鼻中隔移植中，69.7%用于初次鼻整形病例，30.3%用于二次鼻整形。术后第18个月时，98%的患者鼻尖突出度令人满意。
闭合式鼻整形术中，鼻中隔-鼻小柱缝合联合尾侧鼻中隔移植极大地有助于实现美观且功能良好的最终效果，为一系列问题提供了解决方案，如短鼻、鼻尖上区畸形、鼻唇角改变或鼻小柱弯曲。然而，该技术学习曲线较陡；因此，应进行细致的术前评估，实施精确的手术规划，并避免过度降低鼻尖或过度牵拉鼻小柱。
