From the Department of Surgery, Section of Plastic Surgery, Yale University School of Medicine.
Plast Reconstr Surg. 2019 Nov;144(5):772e-780e. doi: 10.1097/PRS.0000000000006178.
Control and maintenance of nasal tip position are critical in rhinoplasty. Two frequent methods of exerting tip control are columellar strut and caudal septal extension graft. However, no quantitative data exist comparing the two methods over time. The purpose of this study was to analyze maintenance of tip projection and rotation following either columellar strut or septal extension graft.
A retrospective cohort study of patients undergoing rhinoplasty was reviewed. Three-dimensional photogrammetric evaluation of patients with either columellar strut or septal extension graft to increase tip projection was performed. Anthropometric points were analyzed in a blinded fashion. Outcome variables were tip projection, nasal length, the Goode ratio, and tip rotation. Results were stratified based on technique and compared statistically.
One hundred six patients were included. Overall, 66 percent were female, with an average age of 34.5 years. A columellar strut was used in 42 percent of cases (n = 45), and a septal extension graft was used in 57 percent (n = 61). Analysis showed greater maintenance of tip rotation over time with the septal extension graft compared with the columellar strut [-1.01 percent change (p = not significant versus -5.08 percent change (p = 0.009)]. Tip projection, nasal length, and the Goode ratio decreased over time for both groups, but the differences were not statistically different.
Nasal tip projection and rotation appear to decrease from the immediate postoperative position. In this study, both septal extension graft and columellar strut exhibit similar changes in tip projection with time; however, septal extension graft is better able to preserve tip rotation compared with the columellar strut.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
在鼻整形术中，控制和维持鼻尖位置是至关重要的。两种常见的鼻尖控制方法是鼻中隔支撑和鼻中隔延伸移植物。然而，目前尚无比较这两种方法随时间推移的效果的定量数据。本研究的目的是分析鼻中隔支撑或鼻中隔延伸移植物增加鼻尖突出度后鼻尖突出度和旋转的维持情况。
回顾性分析接受鼻整形术的患者队列研究。对采用鼻中隔支撑或鼻中隔延伸移植物增加鼻尖突出度的患者进行三维摄影评估。以盲法分析人体测量点。分析的结果变量为鼻尖突出度、鼻长度、古德比和鼻尖旋转。根据技术进行分层，并进行统计学比较。
共纳入 106 例患者。总体而言，66%为女性，平均年龄为 34.5 岁。42%的病例（n=45）采用鼻中隔支撑，57%的病例（n=61）采用鼻中隔延伸移植物。分析显示，与鼻中隔支撑相比，鼻中隔延伸移植物随时间推移对鼻尖旋转的维持作用更好[-1.01%的变化（p=无统计学意义），而鼻中隔支撑为-5.08%的变化（p=0.009）]。两组患者的鼻尖突出度、鼻长度和古德比随时间推移均有下降，但差异无统计学意义。
鼻尖突出度和旋转似乎从术后即刻位置开始减小。在这项研究中，鼻中隔延伸移植物和鼻中隔支撑在随时间推移的鼻尖突出度变化方面表现相似；然而，与鼻中隔支撑相比，鼻中隔延伸移植物更能保持鼻尖旋转。
临床问题/证据水平：治疗性，III 级。
