Ryu Gwanghui, Seo Min Young, Lee Kyung Eun, Hong Sang Duk, Chung Seung-Kyu, Dhong Hun-Jong, Kim Hyo Yeol
Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Clin Exp Otorhinolaryngol. 2018 Dec;11(4):275-280. doi: 10.21053/ceo.2017.01816. Epub 2018 Jun 2.
Middle vault deviation has a significant effect on the aesthetic and functional aspects of the nose, and its management continues to be a challenge. Spreader graft and its modification techniques have been focused, but there has been scarce consideration for removing surplus portion and balancing the upper lateral cartilage (ULC). This study aimed to report the newly invented triangular-shaped resection technique ("triangular resection") of the ULC and to evaluate its efficacy for correcting middle vault deviation.
A retrospective study included 17 consecutive patients who presented with middle vault deviation and underwent septorhinoplasty by using triangular resection at a tertiary academic hospital from February 2014 and March 2016. Their outcomes were evaluated pre- and postoperatively including medical photographs, acoustic rhinometry and subjective nasal obstruction using a 7-point Likert scale.
The immediate outcomes were evaluated around 1 month after surgery, and long-term outcomes were available in 12 patients; the mean follow-up period was 9.1 months. Nasal tip deviation angle was reduced from 5.66º to 2.37º immediately (P<0.001). Middle vault deviation also improved from 169.50º to 177.24º (P<0.001). Long-term results were 2.49º (P=0.015) for nasal tip deviation and 178.68º (P=0.002) for middle vault deviation. The aesthetic outcome involved a complete correction in eight patients (47.1%), a minimally visible deviation in seven patients (41.2%) and a remaining residual deviation in two patients (11.8%). Pre- and postoperative minimal cross-sectional areas (summation of the right and left sides) were 0.86 and 1.07, respectively (P=0.021). Fifteen patients answered about their nasal obstruction symptoms and the median symptom score had alleviated from 6.0 to 3.0 (P=0.004).
Triangular resection of the ULC is a simple and effective method for correcting middle vault deviation and balancing the ULCs without complications as internal nasal valve narrowing.
鼻中段偏斜对鼻子的美学和功能方面有显著影响，对其进行处理仍然是一项挑战。扩展移植物及其改良技术一直是关注焦点，但对于去除多余部分和平衡上外侧软骨（ULC）的考虑却很少。本研究旨在报告新发明的上外侧软骨三角形切除术（“三角切除术”），并评估其纠正鼻中段偏斜的疗效。
一项回顾性研究纳入了2014年2月至2016年3月期间在一家三级学术医院连续17例因鼻中段偏斜接受鼻中隔鼻成形术并采用三角切除术的患者。对他们术前和术后的结果进行评估，包括医学照片、鼻声反射测量以及使用7点李克特量表评估主观鼻阻塞情况。
术后约1个月评估即时结果，12例患者有长期结果；平均随访期为9.1个月。鼻尖偏斜角立即从5.66°降至2.37°（P<0.001）。鼻中段偏斜也从169.50°改善至177.24°（P<0.001）。长期结果为鼻尖偏斜2.49°（P=0.015），鼻中段偏斜178.68°（P=0.002）。美学结果方面，8例患者（47.1%）完全矫正，7例患者（41.2%）偏差几乎不可见，2例患者（11.8%）仍有残余偏差。术前和术后最小横截面积（左右两侧之和）分别为0.86和1.07（P=0.021）。15例患者回答了他们的鼻阻塞症状，症状评分中位数从6.0降至3.0（P=0.004）。
上外侧软骨三角切除术是一种简单有效的方法，可纠正鼻中段偏斜并平衡上外侧软骨，且无鼻内瓣膜狭窄等并发症。
