Uebel Carlos Oscar, Matta Renato
Division of Plasic Surgery -PUCRS, Porto Alegre, Brazil.
Eur J Plast Surg. 2017;40(5):417-426. doi: 10.1007/s00238-017-1336-5. Epub 2017 Jul 12.
Alar cartilage can be very useful for tip and dorsum grafts. Depending on its size and thickness, it can be an important alternative for spreader grafts to improve endonasal functional deficiencies, correct deviated noses, and prevent inverted "V" deformities. Caucasian patients with bulbous tips are the most common candidates to achieve such benefits. It is easy to obtain and to frame into a desired graft.
The authors describe a surgical technique using the alar cartilages as spreader grafts. All Caucasian patients with bulbous tips who underwent primary rhinoplasty were included. All patients have been evaluated after 3 to 4 months and after 1 and 2 years by aesthetical and functional criteria.
Thirty-four patients (28 female and 6 male) underwent this procedure between 2001 and 2015: 94% reported a better airflow, 91% reported very good aesthetic results and were very satisfied 2 years postoperatively, and 12% had nasal deviations that were corrected with a one side double-layered spreader grafts. Two patients presented supra-tip deformities and one patient had a columella scar that was revised surgically. No cases of inverted "V" deformity were reported 2 years postoperatively.
Patients with functional satisfaction and with a straight and smooth dorsum seem to be the most important benefits that were achieved with this technique using alar cartilage spreader grafts, an alternative that can be offered to improve airflow and to prevent deviated and inverted "V" deformities. Level of Evidence: IV, therapeutic study.
鼻翼软骨对鼻尖和鼻背移植非常有用。根据其大小和厚度，它可以成为鼻小柱支撑移植的重要替代物，以改善鼻内功能缺陷、矫正鼻偏斜并预防倒“V”畸形。鼻尖圆钝的白种人患者是最常能从这种移植中获益的人群。鼻翼软骨易于获取并可塑形为所需的移植材料。
作者描述了一种使用鼻翼软骨作为鼻小柱支撑移植的手术技术。纳入所有接受初次鼻整形术的鼻尖圆钝的白种人患者。所有患者在术后3至4个月以及1年和2年后均通过美学和功能标准进行评估。
2001年至2015年间，34例患者（28例女性和6例男性）接受了该手术：94%的患者报告气流改善，91%的患者报告美学效果非常好且术后2年非常满意，12%的患者存在鼻偏斜，通过单侧双层鼻小柱支撑移植进行了矫正。2例患者出现鼻尖上区畸形，1例患者的鼻小柱瘢痕通过手术进行了修复。术后2年未报告倒“V”畸形病例。
功能满意且鼻背笔直光滑的患者似乎是使用鼻翼软骨鼻小柱支撑移植技术所取得的最重要益处，这是一种可用于改善气流并预防鼻偏斜和倒“V”畸形的替代方法。证据级别：IV级，治疗性研究。
