Bronx, N.Y.
From the Department of Otorhinolaryngology-Head and Neck Surgery, Jacobi Medical Center, Albert Einstein College of Medicine.
Plast Reconstr Surg. 2018 Feb;141(2):312-321. doi: 10.1097/PRS.0000000000004059.
Tension nose deformity is believed to be caused by an "oversized" septal quadrangular cartilage. Prior studies have shown that quadrangular cartilage size is relatively consistent in populations. The authors hypothesize that the tension nose deformity is actually caused by an external extrusion of a normal sized septal cartilage from an undersized bony septal encasement.
A retrospective case-control study of sagittal computed tomographic scans was conducted, measuring the perimeter and surface area of the quadrangular cartilage and bony septal aperture in tension nose cases and controls. Statistical analysis was performed.
Of 23 patients enrolled in the study, 12 patients were sorted into the tension nose group, and 11 patients were considered controls. Both groups had similar perimeter and surface area of their quadrangular cartilage, without statistical difference between the two groups. However, the tension nose group had a statistically significant reduction in bony septal aperture perimeter compared with controls (p < 0.01) and a larger externally extruded septum compared with their internal septal size. They also had a substantially higher rate of septal deviation than controls.
The results of this study suggest that a mismatch between a small bony septal aperture and a normal sized septal quadrangular cartilage may be responsible for caudal, upper lip, and dorsal fullness seen with the tension nose deformity caused by external extrusion of cartilage. Septal deviation may co-occur as a buckling phenomenon in a limited bony space. Surgical strategies to match the entire quadrangular cartilage size to the bony framework are suggested.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
张力性鼻畸形被认为是由“过大”的鼻中隔四角软骨引起的。先前的研究表明，四角软骨的大小在人群中相对一致。作者假设张力性鼻畸形实际上是由正常大小的鼻中隔软骨从较小的骨性鼻中隔包裹中向外挤压引起的。
对矢状位计算机断层扫描进行回顾性病例对照研究，测量张力性鼻畸形病例和对照组的四角软骨和骨性鼻中隔孔的周长和表面积。进行了统计分析。
在 23 名入组研究的患者中，12 名患者被归入张力性鼻组，11 名患者被认为是对照组。两组的四角软骨周长和表面积相似，两组之间无统计学差异。然而，与对照组相比，张力性鼻组的骨性鼻中隔孔周长有统计学显著减小（p < 0.01），并且与内部鼻中隔大小相比，外部挤出的鼻中隔更大。他们的鼻中隔偏曲率也明显高于对照组。
本研究结果表明，小骨性鼻中隔孔径与正常大小的鼻中隔四角软骨之间不匹配，可能是导致张力性鼻畸形出现尾部、上唇和背部饱满的原因，这种畸形是由于软骨向外挤压所致。鼻中隔偏曲可能同时发生在有限的骨空间中作为一种弯曲现象。建议采用将整个四角软骨大小与骨性框架相匹配的手术策略。
临床问题/证据水平：风险，III 级。
