Saban Y
Cabinet du Dr Yves Saban, 31 avenue Jean Médecin, 06000, Nice, France.
HNO. 2018 Jan;66(1):15-25. doi: 10.1007/s00106-017-0454-5.
Reshaping the nose can be achieved following 3 main concepts: preservation and reshaping of normal anatomy, resection of nasal deformities, reconstruction of nasal framework. Time, experience and nasal anatomic knowledge are keys to understand nasal biomechanics.
To describe how experience and morphodynamic anatomy lead to a new concept of sequential primary rhinoplasty, resulting in reducing revision rhinoplasties.
Through 36 years' experience in different rhinoplasty procedures, 25 years in personal anatomic studies of the nose and reviewing the last 15 years including 600 patients who underwent new concepts in primary rhinoplasty out of 1200 patients operated during this period, the author analyzes how nasal anatomic layers, surgical approaches, and morphological effect of the time interact to modify the aesthetic results according to current rhinoplasty concepts.
Nasal bony cartilaginous vaults biomechanics understanding leads to consider the K‑area as a flexible joint which can be reshaped without resection of the nasal vaults. The role of the subdorsal septum is highlighted as the main anatomic structure which can be safely resected in rhinoplasty, and which allows to respect the natural anatomy, the nasal valves and the dorsal aesthetic lines. Description of nasal compartments divided by the "T" ligament leads to rethink the incisions and approaches of the nose: the interseptal-columellar and extended infracartilaginous incisions allow to protect nasal ligaments and to perform a deep plane undermining. Protection of the anatomic layers allows quick recovery, nasal function improvement and long-lasting results.
The goal to reduce the rate of revision rhinoplasty and to improve the natural results can be achieved, considering the concept of sequential primary rhinoplasty. Nasal soft tissues are protected as far as possible. The current rhinoplasty concepts are not antagonist but appear as an intraoperative succession of alternative techniques from anatomy and function preservation to reconstruction of the nasal framework.
鼻整形可通过以下三个主要概念实现：保留和重塑正常解剖结构、切除鼻畸形、重建鼻支架。时间、经验和鼻解剖知识是理解鼻生物力学的关键。
描述经验和形态动力学解剖如何引出连续一期鼻整形的新概念，从而减少鼻整形修复手术。
通过36年不同鼻整形手术的经验、25年对鼻部的个人解剖学研究以及回顾过去15年，在此期间共1200例手术患者中有600例接受了一期鼻整形的新概念，作者分析了鼻解剖层次、手术入路以及时间的形态学效应如何相互作用，以根据当前鼻整形概念改变美学效果。
对鼻骨软骨穹窿生物力学的理解促使将K区视为一个可在不切除鼻穹窿的情况下进行重塑的灵活关节。鼻中隔背侧下方的作用被突出为鼻整形中可安全切除的主要解剖结构，并且这允许尊重自然解剖结构、鼻瓣膜和鼻背美学线。对由“T”韧带分隔的鼻腔间隔的描述促使重新思考鼻的切口和入路：鼻中隔 - 小柱切口和延伸的软骨下切口允许保护鼻韧带并进行深平面剥离。对解剖层次的保护可实现快速恢复、改善鼻功能并获得持久效果。
考虑连续一期鼻整形的概念，可实现降低鼻整形修复率并改善自然效果的目标。尽可能保护鼻软组织。当前的鼻整形概念并非相互对立，而是呈现为从解剖结构和功能保留到鼻支架重建的一系列术中替代技术。
