Şirinoğlu Hakan
Department of Plastic Reconstructive and Aesthetic Surgery, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Kartal, Istanbul, Turkey.
Aesthetic Plast Surg. 2017 Feb;41(1):146-152. doi: 10.1007/s00266-016-0727-5. Epub 2016 Dec 28.
The maintenance of desired tip projection and rotation is an important goal in rhinoplasty. In this study, the effects of the columellar strut graft and septocolumellar sutures were evaluated in a follow-up period of 1 year.
In half of 44 patients, nasal tip was constructed with basic tip maneuvers and two septocolumellar sutures (Group-1, Suture Group), whereas in the remaining 22 patients, a columellar strut graft was added for tip support (Group-2, Suture + Graft Group). Standardized right profile images were taken preoperatively, 1 month postoperatively and 1 year postoperatively. Nasal tip projection was evaluated using Goode's method. For the evaluation of tip rotation, the nasolabial angle was measured. The results were statistically compared, and a p value lower than 0.05 was considered as significant.
Between the postoperative first month to first year, the loss of tip projection was 3.8% in Group-1 and 3.5% in Group-2 which was statistically insignificant (p value 0.942). The loss of tip rotation was found as 4.6° (4.1%) in Group-1 and 4.6° (4.0%) in Group-2 which was also statistically insignificant (p value 0.979).
Considering the results of the study, in most of the primary cases, two septocolumellar sutures in conjunction with basic tip maneuvers are sufficient for positioning and stabilizing of the nasal tip, and a short and floating columellar strut graft does not have any affect in maintenance of the desired nasal tip rotation and projection.
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维持理想的鼻尖突出度和旋转度是鼻整形术的一个重要目标。在本研究中,对鼻中隔支柱移植和鼻中隔-鼻小柱缝合在1年随访期内的效果进行了评估。
44例患者中,一半采用基本鼻尖手术操作和两根鼻中隔-鼻小柱缝合构建鼻尖(第1组,缝合组),而其余22例患者则添加鼻中隔支柱移植以支撑鼻尖(第2组,缝合+移植组)。术前、术后1个月和术后1年拍摄标准化的右侧位图像。采用古德法评估鼻尖突出度。为评估鼻尖旋转度,测量鼻唇角。对结果进行统计学比较,p值低于0.05被认为具有显著性。
术后第1个月至第1年,第1组鼻尖突出度的丢失率为3.8%,第2组为3.5%,差异无统计学意义(p值0.942)。第1组鼻尖旋转度的丢失为4.6°(4.1%),第2组为4.6°(4.0%),差异也无统计学意义(p值0.979)。
考虑到本研究结果,在大多数初治病例中,两根鼻中隔-鼻小柱缝合结合基本鼻尖手术操作足以定位和稳定鼻尖,短而游离的鼻中隔支柱移植对维持理想的鼻尖旋转度和突出度没有任何影响。
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