Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota.
Department of Radiology, Mayo Clinic, Rochester, Minnesota.
JAMA Facial Plast Surg. 2019 Dec 1;21(6):511-517. doi: 10.1001/jamafacial.2019.0715.
Preoperative assessment of nasal soft-tissue envelope (STE) thickness is an important component of rhinoplasty that presently lacks validated tools.
To measure and assess the distribution of nasal STE thickness in a large patient population and to determine if facial plastic surgery clinicians can predict nasal STE thickness based on visual examination of the nose.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective review and prospective assessment of 190 adult patients by 4 expert raters was conducted at an academic tertiary referral center. The patients had high-resolution maxillofacial computed tomography (CT) scans and standardized facial photographs on file and did not have a history of nasal fracture, septal perforation, rhinoplasty, or other surgery or medical conditions altering nasal form. Data were analyzed in March 2019.
Measure nasal STE thickness at defined anatomic subsites using high-resolution CT scans. Measure expert-predicted nasal STE thickness based on visual examination of the nose using a scale from 0 (thinnest) to 100 (thickest).
Of the 190 patients, 78 were women and the mean (SD) age was 45 (17) years. The nasal STE was thickest at the sellion (mean [SD]) (6.7 [1.7] mm), thinnest at the rhinion (2.1 [0.7] mm), thickened over the supratip (4.8 [1.0] mm) and nasal tip (3.1 [0.6] mm), and thinned over the columella (2.6 [0.4] mm). In the study population, nasal STE thickness followed a nearly normal distribution for each measured subsite, with the majority of patients in a medium thickness range. Comparison of predicted and actual nasal STE thickness showed that experts could accurately predict nasal STE thickness, with the highest accuracy at the nasal tip (r, 0.73; prediction accuracy, 91%). A strong positive correlation was noted among the experts' STE estimates (r, 0.83-0.89), suggesting a high level of agreement between individual raters.
There is variable thickness of the nasal STE, which influences the external nasal contour and rhinoplasty outcomes. With visual analysis of the nose, experts can agree on and predict nasal STE thickness, with the highest accuracy at the nasal tip. These data can aid in preoperative planning for rhinoplasty, allowing implementation of preoperative, intraoperative, and postoperative strategies to optimize the nasal STE, which may ultimately improve patient outcomes and satisfaction.
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术前评估鼻软组织包被（STE）厚度是鼻整形术的一个重要组成部分，但目前缺乏经过验证的工具。
测量和评估大量患者人群的鼻 STE 厚度分布，并确定面部整形手术医生是否可以根据对鼻子的视觉检查来预测鼻 STE 厚度。
设计、设置和参与者：这是一项在学术性三级转诊中心对 190 名成年患者进行的回顾性研究和前瞻性评估，由 4 名专家评估员进行。这些患者有高分辨率颌面计算机断层扫描（CT）扫描和标准面部照片存档，且没有鼻骨折、鼻中隔穿孔、鼻整形术或其他改变鼻形的手术或医疗状况史。数据分析于 2019 年 3 月进行。
使用高分辨率 CT 扫描在特定解剖部位测量鼻 STE 厚度。根据对鼻子的视觉检查，使用 0（最薄）至 100（最厚）的量表测量专家预测的鼻 STE 厚度。
在 190 名患者中，78 名女性，平均（SD）年龄为 45（17）岁。鼻 STE 在sellion 处最厚（平均[SD]）（6.7[1.7]mm），在 rhinion 处最薄（2.1[0.7]mm），在 supratip 和 nasal tip 处增厚（4.8[1.0]mm 和 3.1[0.6]mm），在 columella 处变薄（2.6[0.4]mm）。在研究人群中，每个测量部位的鼻 STE 厚度均呈近似正态分布，大多数患者处于中等厚度范围。预测和实际鼻 STE 厚度的比较表明，专家可以准确预测鼻 STE 厚度，在鼻尖处的准确性最高（r=0.73；预测准确性为 91%）。专家的 STE 估计值之间存在很强的正相关（r=0.83-0.89），表明各个评估者之间具有高度的一致性。
鼻 STE 厚度存在差异，这会影响外鼻轮廓和鼻整形术的结果。通过对鼻子的视觉分析，专家可以就鼻 STE 厚度达成一致并进行预测，在鼻尖处的准确性最高。这些数据可以帮助鼻整形术的术前规划，实施术前、术中和术后策略来优化鼻 STE，这可能最终改善患者的结果和满意度。
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