From the Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Medical Center; and the Dallas Plastic Surgery Institute.
Plast Reconstr Surg. 2020 Jun;145(6):1389-1401. doi: 10.1097/PRS.0000000000006850.
Dorsal hump reduction during open rhinoplasty disrupts the continuity between the upper lateral cartilages and the dorsal septum. Options to reconstitute the midvault include primary closure of the upper lateral cartilages to the dorsal aspect of the septum, placement of spreader grafts, and creation of spreader flaps. The authors sought to clarify from highly experienced rhinoplasty surgeons their decision-making rationale for midvault reconstruction, distilling down the group consensus into algorithmic guidelines.
A panel of internationally recognized rhinoplasty surgeons participated in a two-part organized communication method. An introductory summit consisted of open discussions on various topics in midvault reconstruction. The summit transcription was analyzed by thematic content analysis to develop a survey encompassing clinical scenarios for primary rhinoplasty, which was then individually administered to each panelist. Data gathered from both parts were used to generate technical guidelines and a decision-making algorithm.
The panelists identified the following anatomical features as pertinent to their selection of midvault reconstruction method: size of the dorsal hump reduction, width of the midvault relative to the upper vault, presence of dorsal angulation, and presence of nasal obstructive symptoms. Individual panelist preference was gathered from the 24-scenario survey divided into either cosmetic or functional rhinoplasty cases.
Management of the midvault after dorsal hump reduction is important to establish proper aesthetic relationships and to provide functional integrity of the internal valve. Our authors present an algorithmic approach to decision-making based on the systematic analysis practiced by senior rhinoplasty surgeons.
开放式鼻整形术中减少背驼峰会破坏上外侧软骨和鼻中隔背侧之间的连续性。重建中隔的方法包括将上外侧软骨直接缝合到鼻中隔的背侧、放置移植物和创建移植物皮瓣。作者旨在向经验丰富的鼻整形术医生澄清其中隔重建的决策思路，将小组共识提炼成算法指南。
一组国际知名的鼻整形术医生参与了两部分有组织的交流方法。一个介绍性的峰会由关于中隔重建的各种主题的公开讨论组成。峰会记录的转录本通过主题内容分析进行分析，以开发一个涵盖原发性鼻整形术的临床情景的调查，然后单独向每位小组成员进行管理。从这两部分收集的数据用于生成技术指南和决策算法。
小组成员确定了以下解剖特征与他们选择中隔重建方法有关：背驼峰减少的大小、中隔相对于上隔的宽度、存在背侧成角和存在鼻塞症状。从 24 个情景调查中收集了每位小组成员的个人偏好，该调查分为美容或功能性鼻整形术病例。
在减少背驼峰后处理中隔很重要，以建立适当的美学关系并提供内部瓣膜的功能完整性。我们的作者提出了一种基于高级鼻整形术医生实践的系统性分析的决策算法方法。
