Department of Plastic and Reconstructive Surgery, Ajou University, School of Medicine, Suwon, Korea.
Department of Plastic and Reconstructive Surgery, Ulsan university, College of medicine, Asan medical center, Seoul, Korea.
J Plast Reconstr Aesthet Surg. 2021 Aug;74(8):1824-1831. doi: 10.1016/j.bjps.2020.12.023. Epub 2020 Dec 14.
The nasal aesthetic subunit principle has been widely accepted as the standard for nasal reconstruction with forehead flaps. However, in our experience, one's impression of a reconstructed face can easily be represented by the nose's entire appearance rather than a single nasal component. Accordingly, we hypothesized that total nasal reconstruction focusing more on the facial aesthetic subunit principle would be superior to focal nasal subunit partial reconstruction. Here, we investigated the indication range of total nasal reconstruction and analyzed its effectiveness. Between July 2006 and December 2017, 32 patients who underwent total or subtotal nasal reconstruction were recruited. The total nasal reconstruction group (n = 20) was treated according to our modified facial aesthetic unit concept, while the subtotal reconstruction group (n = 16) was treated according to the nasal aesthetic subunit principle. Using retrospective reviews, we compared surgical details and aesthetic, and functional outcomes with visual analog scale scores. In aesthetic evaluation, nose contour (p = 0.009), nasal symmetry (p = 0.001), and nostril shape (p = 0.041) were superior in the total nasal reconstruction group. Satisfaction regarding the nose (p = 0.036) was significantly higher than that regarding the forehead and labial folds in the total group. Regarding function, there were no significant intergroup differences in nasal airflow, snoring, or olfaction. We suggest that total nasal reconstruction is not a strategy to avoid because of its aggressive nature. For selected suitable patients, the use of the total nose reconstruction focusing on our one nose concept can be a successful surgical option, and the reconstructed nose can be visualized as a real part of the face.
鼻美学亚单位原则已被广泛接受，作为额瓣鼻重建的标准。然而，根据我们的经验，一个人对面部的印象很容易通过鼻子的整体外观而不是单个鼻亚单位来体现。因此，我们假设，更多地关注面部美学亚单位原则的全鼻重建将优于局部鼻亚单位部分重建。在这里，我们研究了全鼻重建的适应证范围，并分析了其效果。2006 年 7 月至 2017 年 12 月，共招募了 32 例接受全鼻或部分全鼻重建的患者。全鼻重建组（n=20）根据我们改良的面部美学单位概念进行治疗，而部分全鼻重建组（n=16）则根据鼻美学亚单位原则进行治疗。通过回顾性研究，我们比较了手术细节和美学、功能结果，并采用视觉模拟评分法进行评估。在美学评估中，全鼻重建组的鼻轮廓（p=0.009）、鼻对称性（p=0.001）和鼻孔形状（p=0.041）更优。对鼻子的满意度（p=0.036）显著高于对额头和唇褶的满意度。关于功能，两组之间在鼻气流、打鼾或嗅觉方面无显著差异。我们建议，不要因为全鼻重建的侵袭性而避免使用这种方法。对于选择合适的患者，使用我们的一个鼻子概念的全鼻重建可以是一种成功的手术选择，重建的鼻子可以被视为面部的真实部分。
