Sertel Serkan, Venara-Vulpe Ioana Irina, Pasche Philippe
Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
Department of Otorhinolaryngology, Head & Neck Surgery, University of Heidelberg, Heidelberg, Germany.
J Otolaryngol Head Neck Surg. 2016 Mar 10;45:19. doi: 10.1186/s40463-016-0131-9.
Silicone Implants and other alloplastic materials are frequently used in rhinoplasty to augment Asian short noses. However, nasal deformities as a result of implant-related infections are increasing in incidence. The resulting tissue scarrings hinder the application of traditional techniques of lengthening short noses. The following paper presents a technique to correct severe postoperative retractions of the tip and columella caused by silicone implants.
We present a retrospective case study of two Asian patients with recurrent acute infections, secondary to silicone dorsum implants, leading to chronic inflammation of the tip and columella. The treatment consisted of implant removal and the immediate nasal reconstruction by combining uni- or bilateral gingivobuccal flaps along with L-shaped costal cartilage grafting. To evaluate the surgical results, various anthropometric measurements, particularly the nasal length (NL) and nasal tip projection (NTP) of pre- and postoperative profile photographs, were analyzed.
Successful nasal lengthening and correction of columellar retraction were achieved. In case I, postoperative NTP and NL increased by 34.7% and 21.1%, respectively. In case II, NL and NTP increased by 23.8% and 10.6%, respectively. However, case II presented necrosis of the distal extremity of one gingivobuccal flap without rib graft resorption, which later healed by secondary intention.
Pronounced columellar retraction in severe short noses can be successfully managed with a combination of gingivobuccal flaps along with L-shaped costal cartilage grafting. The use of autologous materials decreases the risk of long-term extrusion through the tip. The gingivobuccal flap provides vascularity to the exposed rib cartilage on the columella and prevents its resorption.
硅胶植入物和其他异体材料常用于鼻整形手术以改善亚洲人的短鼻。然而，与植入物相关的感染导致的鼻畸形发病率正在上升。由此产生的组织瘢痕阻碍了传统短鼻延长技术的应用。以下论文介绍了一种纠正硅胶植入物导致的鼻尖和鼻小柱严重术后回缩的技术。
我们对两名亚洲患者进行了一项回顾性病例研究，这两名患者因硅胶鼻背植入物继发反复急性感染，导致鼻尖和鼻小柱慢性炎症。治疗包括取出植入物，并通过联合单侧或双侧龈颊瓣以及L形肋软骨移植立即进行鼻重建。为了评估手术效果，分析了各种人体测量数据，特别是术前和术后侧面照片的鼻长度（NL）和鼻尖突出度（NTP）。
成功实现了鼻延长和鼻小柱回缩的矫正。在病例I中，术后NTP和NL分别增加了34.7%和21.1%。在病例II中，NL和NTP分别增加了23.8%和10.6%。然而，病例II出现了一个龈颊瓣远端坏死，肋软骨移植未吸收，后来通过二期愈合。
严重短鼻中明显的鼻小柱回缩可以通过龈颊瓣联合L形肋软骨移植成功治疗。使用自体材料可降低长期从鼻尖挤出的风险。龈颊瓣为鼻小柱上暴露的肋软骨提供血供并防止其吸收。
