Kovacevic M, Buttler E, Haack S, Riedel F, Veit J A
HNO-Praxis Hanse-Viertel, Hamburg, Deutschland.
Praxis für funktionelle und ästhetische Nasenchirurgie, München, Deutschland.
HNO. 2021 Oct;69(10):817-827. doi: 10.1007/s00106-020-00949-3. Epub 2020 Sep 29.
Nasal dorsum deprojection is a very important tool in functional and aesthetic rhinoplasty. In classic techniques, resection of dorsal bone and cartilage renders dorsal reconstruction necessary. The concept of dorsal preservation rhinoplasty has been known for more than a century but has experienced a renaissance in recent years, with many critical technical modifications.
We present the latest technique of piezo-assisted dorsal preservation rhinoplasty with subdorsal triangular resection and subdorsal Cottle modification based on clinical experience of 205 cases. Furthermore, the advantages and disadvantages of this technique are discussed and several other current variations are presented.
Piezo-assisted osteotomy enables a very precise fracture line and sparing of periosteum, with bone sculpting possible even after mobilization. Subdorsal septal height reduction always precedes completion of the osteotomy and nasal bone mobilization, to ensure patient safety with regard to skull base injury. Using the presented technical modifications, the risk of step deformities in the radix is minimized. In selected patients, dorsal preservation septorhinoplasty enables the surgeon to perform very conservative and precise deprojection of the nose with excellent outcomes, although the spectrum of possible complications is shifted in comparison to classic techniques.
The preliminary experience of 205 cases with a revision rate of less than 10% is promising. A final evaluation of the technique will only be possible after further studies and evaluation of long-term results.
鼻背降低术是功能性和美容性鼻整形术中一项非常重要的技术。在传统技术中，切除鼻背骨和软骨后需要进行鼻背重建。鼻背保留鼻整形术的概念已为人所知超过一个世纪，但近年来经历了复兴，出现了许多关键的技术改进。
基于205例临床经验，我们介绍了压电辅助鼻背保留鼻整形术的最新技术，包括鼻背下三角切除和鼻背下科特尔改良术。此外，还讨论了该技术的优缺点，并介绍了其他几种当前的变体。
压电辅助截骨术能够形成非常精确的骨折线并保留骨膜，即使在骨块移动后也可以进行骨塑形。鼻背下鼻中隔高度降低总是在截骨术和鼻骨移动完成之前进行，以确保患者颅骨底损伤的安全。使用所介绍的技术改进，鼻根处阶梯状畸形的风险降至最低。在选定的患者中，鼻背保留鼻中隔鼻整形术使外科医生能够非常保守和精确地降低鼻背，效果极佳，尽管与传统技术相比，可能的并发症范围有所不同。
205例初步经验，修复率低于10%，前景乐观。只有在进一步研究和评估长期结果后，才能对该技术进行最终评估。
