Ghareeb Fouad Mohammed, Nassar Ahmed Tharwat, Talaab Ahmed Abdelaziz, Alkashty Sherief
Faculty of Medicine, Menoufia University, Egypt.
Plast Reconstr Surg Glob Open. 2018 Oct 22;6(10):e1862. doi: 10.1097/GOX.0000000000001862. eCollection 2018 Oct.
The predominant character in the Middle Eastern noses is the thick skin, weak cartilages, amorphous bulbous nasal tip, and high incidence of postoperative supra-tip swelling, compared with the Caucasian noses. The purpose of this study was to describe some anatomical findings and find techniques to improve outcomes in these patients.
This is retrospective study in 624 patients of Middle Eastern origin, where the characteristic anatomical findings are described and the surgical endeavors to combat their detrimental effect on the outcomes of rhinoplasty are explained.
The results have shown that in these 624 patients, 365 patients had excellent results, 223 patients had average results, while 36 patients had poor results.
The nasal shape depends on the skin (skin barring) or the cartilages (cartilage barring), or both (skin and cartilage sharing). Middle Eastern patients are toward the skin barring category with the lateral crus of the lower lateral cartilage very broad with a lateral fibrous attachment replacing the minor (sesamoid) cartilages leading to ill definition of the alae from the sides of the nose. Outcomes in these patients were improved by identification and release of these lateral attachment to improve the bulbous tip and define the alar subunit from the side of the nose. Cephalic rotation is achieved mainly by M-shaped excision of the inner lining of the vestibule and the caudal part of the septum. Other methods described to combat the strong skin memory and allow skin to configure after surgery.
与高加索人鼻子相比，中东人鼻子的主要特征是皮肤厚、软骨薄弱、鼻尖呈无定形球根状，且术后鼻尖上区肿胀发生率高。本研究的目的是描述一些解剖学发现，并找到改善这些患者手术效果的技术。
这是一项对624名中东裔患者的回顾性研究，描述了其特征性解剖学发现，并解释了为对抗其对隆鼻手术效果的不利影响而采取的手术措施。
结果显示，在这624名患者中，365名患者效果极佳，223名患者效果一般，36名患者效果较差。
鼻形取决于皮肤（皮肤主导型）或软骨（软骨主导型），或两者兼有（皮肤和软骨共同主导型）。中东患者属于皮肤主导型，下外侧软骨的外侧脚非常宽，外侧纤维附着取代了小（籽状）软骨，导致鼻翼从鼻侧的界定不清。通过识别并松解这些外侧附着，改善球根状鼻尖并从鼻侧界定鼻翼亚单位，可改善这些患者的手术效果。鼻尖上旋主要通过对前庭内衬和鼻中隔尾侧部分进行M形切除来实现。还描述了其他对抗强烈皮肤记忆并使皮肤在术后塑形的方法。
