改良前间隔移植的技术改进与结果。
Technical Refinements and Outcomes of the Modified Anterior Septal Transplant.
机构信息
Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland.
出版信息
JAMA Facial Plast Surg. 2018 Jan 1;20(1):31-36. doi: 10.1001/jamafacial.2017.1040.
IMPORTANCE
Severe anterior septal deviation and resultant nasal obstruction represent a difficult surgical task to correct. The goal of surgery is to straighten the anterior dorsal and caudal struts, while maintaining nasal tip and midvault support. This study presents a novel extracorporeal septoplasty technique to straighten the crooked anterior septum.
OBJECTIVE
To describe the novel anterior septal transplant technique, which consists of complete resection of the caudal septum and reconstruction with extended spreader grafts and a columellar strut, without a separate caudal septal replacement graft.
DESIGN, SETTING, AND PARTICIPANTS: This study was a retrospective case series at a tertiary academic referral center. Participants were sequential adult patients undergoing anterior septal transplant from January 1, 2008, to December 31, 2015.
MAIN OUTCOMES AND MEASURES
Patient-reported nasal obstruction using Nasal Obstruction Symptom Evaluation (NOSE) scores and objective photographic analysis. Nasal tip deviation, projection, and rotation were measured. Preoperative and postoperative outcomes were compared. Complications are reported.
RESULTS
Seventy-one patients (mean age, 46 years [age range, 16-72 years]; 48 [67.6%] female and 23 [32.4%] male) were included in the case series. Postoperative NOSE scores (mean [SD], 24.00 [24.58]) were significantly better than preoperative NOSE scores (mean [SD], 72.25 [14.55]) (P < .001). A separate cohort of 32 patients (mean age, 42 years [age range, 13-72 years]; 23 [71.9%] female and 9 [28.1%] male) had photographs available for analysis. In the frontal view, nasal deviation improved from a mean (SD) of 2.9 (2.0) degrees before surgery to a mean (SD) of 1.4 (1.7) degrees after surgery (P = .004). In the base view, the deviation was corrected from a mean (SD) of 4.9 (2.8) degrees to a mean (SD) of 1.7 (1.2) degrees (P < .001). Tip rotation and projection were unchanged after surgery. Four patients had mild dorsal irregularities after surgery.
CONCLUSIONS AND RELEVANCE
Anterior septal transplant by the described technique is a safe and effective treatment option for severe anterior septal deviation.
LEVEL OF EVIDENCE
重要性
严重的前鼻中隔偏曲和由此导致的鼻阻塞是一个难以矫正的手术难题。手术的目标是矫正前背侧和尾侧的支柱，同时保持鼻尖和中隔穹窿的支撑。本研究提出了一种新的鼻中隔成形术技术，用于矫正弯曲的前鼻中隔。
目的
描述一种新的鼻中隔移植技术，该技术包括完全切除鼻中隔尾侧部，并使用扩展的撑开移植物和鼻中隔支柱进行重建，而无需单独的鼻中隔尾侧部替换移植物。
设计、地点和参与者：这是一项回顾性病例系列研究，在一家三级学术转诊中心进行。参与者为 2008 年 1 月 1 日至 2015 年 12 月 31 日期间接受前鼻中隔移植的连续成年患者。
主要结果和测量指标
使用鼻阻塞症状评估（NOSE）评分和客观的照片分析评估患者的鼻阻塞情况。测量鼻尖偏斜、突出和旋转。比较术前和术后的结果。报告并发症。
结果
71 例患者（平均年龄 46 岁[年龄范围 16-72 岁]；48 例[67.6%]为女性，23 例[32.4%]为男性）纳入病例系列。术后 NOSE 评分（平均[标准差]，24.00[24.58]）明显优于术前 NOSE 评分（平均[标准差]，72.25[14.55]）（P<0.001）。另一组 32 例患者（平均年龄 42 岁[年龄范围 13-72 岁]；23 例[71.9%]为女性，9 例[28.1%]为男性）有可供分析的照片。在正面视图中，鼻偏斜从术前的平均（标准差）2.9（2.0）度改善到术后的平均（标准差）1.4（1.7）度（P=0.004）。在基底视图中，偏斜从术前的平均（标准差）4.9（2.8）度改善到术后的平均（标准差）1.7（1.2）度（P<0.001）。术后鼻尖旋转和突出无变化。术后 4 例患者出现轻度背侧不规则。
结论和相关性
采用所描述技术的前鼻中隔移植是治疗严重前鼻中隔偏曲的一种安全有效的治疗选择。
证据水平
4 级。
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