Cochran C Spencer, Sieber David A
Dallas, Texas; and San Francisco, Calif.
From the Dallas Rhinoplasty Center; the Departments of Plastic Surgery and Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center; and Sieber Plastic Surgery.
Plast Reconstr Surg. 2017 Oct;140(4):559e-567e. doi: 10.1097/PRS.0000000000003719.
Modification of the lower lateral cartilage complex is the sine qua non of modern rhinoplasty, and the open approach to rhinoplasty has expanded the number of techniques available to help achieve an aesthetically pleasing tip. The ideal tip has been described as having a diamond-shaped configuration, with the lateral points formed by the tip-defining points, the superior point by the supratip, and the inferior point by the columellar break point. Over the years, various techniques have been described to minimize isolation of the tip and to help achieve the ideal tip configuration: lateral crural strut grafts, alar contour grafts (i.e., rim grafts), alar strut grafts, subdomal grafts, and suturing techniques such as alar flaring sutures. The authors present their technique of the extended alar contour graft, which represents an evolution of the lateral crural strut graft and its marriage with the alar contour graft. Lateral crural abnormalities do not usually occur singularly, but rather are the result of an interplay of several factors. Nevertheless, the recurring theme of orientation and alar support to prevent isolation of the tip by extended alar grooves remains. Extended alar contour grafts are a versatile technique to optimize tip shape and orientation by combining the many positive attributes of lateral crural strut grafts and alar contour grafts.
下外侧软骨复合体的调整是现代鼻整形术的关键所在，而开放式鼻整形术拓展了有助于实现美观鼻尖的技术种类。理想的鼻尖被描述为具有菱形形态，外侧点由鼻尖界定点形成，上方点由鼻尖上区形成，下方点由鼻小柱断点形成。多年来，已描述了多种技术来尽量减少鼻尖的分离并帮助实现理想的鼻尖形态：外侧脚支撑移植物、鼻翼轮廓移植物（即边缘移植物）、鼻翼支撑移植物、穹窿下 移植物以及诸如鼻翼扩开缝线等缝合技术。作者介绍了他们的延长鼻翼轮廓移植物技术，该技术是外侧脚支撑移植物的一种演变形式，并将其与鼻翼轮廓移植物相结合。外侧脚异常通常并非单独出现，而是多种因素相互作用的结果。然而，通过延长鼻翼沟来防止鼻尖分离的定向和鼻翼支撑这一反复出现的主题依然存在。延长鼻翼轮廓移植物是一种通用技术，通过结合外侧脚支撑移植物和鼻翼轮廓移植物的诸多积极特性来优化鼻尖形状和定向。
