Department of Maxillo-Facial Surgery, Ortognatica Roma, Roma, Italy.
Dipartimento di Scienze Odontostomatologiche e Maxillo-Facciale, "La Sapienza" Università di Roma, Roma, Italy.
Facial Plast Surg. 2021 Jun;37(3):376-382. doi: 10.1055/s-0041-1722915. Epub 2021 Feb 1.
This study aimed to present a novel approach to correct nasal tip deviation with monolateral crural overlay or monolateral dome truncation, presenting as an isolated deformity or in complex nose deviations. Nasal tip deviation can be congenital or posttraumatic, due to a dislocated septum or cartilaginous septal or lower lateral cartilage malformations. Although some treatment strategies have been introduced, appropriate treatment remains a challenge because of the complexity and variability of such deformities. It had been assumed that in most nasal tip deviations, a lower lateral cartilage was longer than the contralateral one. The authors analyzed 158 patients from January 2015 to October 2019 with nasal tip deviation and corrected the deviated tip by using a monolateral interruptive technique (lateral crural overlay or monolateral dome truncation) on the lower lateral cartilage. Photographic comparison between preoperative and at least 1-year follow-up for nasal axis deviation variable was analyzed and a self-assessment questionnaire was administrated to the patients at 1-year follow-up. The mean nasal deviation was 6.59° (±3.1°) preoperatively and 1.56° (±0.26°) postoperatively ( < 0.05). The range of differences between pre and postoperative deviations was 2.7° to 15.1°, and the mean difference was 6.1° (±3.21°). Of the 84 patients, 47 (55.95%) were very satisfied, 33 (39.28%) were satisfied, and 4 (4.76%) were unsatisfied with surgical the results and required revision surgery. In authors' hands, monolateral interruptive techniques (lateral crural overlay or monolateral dome truncation) are a viable and feasible option to restore nasal tip symmetry. These techniques achieved high satisfaction rates among patients and resulted in reliable and reproducible symmetry immediately visible after surgery and stable over time (1-year postsurgery controls).
本研究旨在提出一种新的方法来矫正单侧穹隆或单侧穹隆截断引起的鼻尖偏斜，这些偏斜表现为孤立性畸形或复杂的鼻偏曲。鼻尖偏斜可由鼻中隔脱位或软骨性鼻中隔或下外侧软骨畸形引起的先天性或外伤性引起。尽管已经引入了一些治疗策略，但由于这种畸形的复杂性和可变性，适当的治疗仍然是一个挑战。人们曾认为，在大多数鼻尖偏斜中，下外侧软骨比对侧长。作者分析了 2015 年 1 月至 2019 年 10 月的 158 例鼻尖偏斜患者，通过在下外侧软骨上使用单侧中断技术（外侧穹隆覆盖或单侧穹隆截断）矫正偏斜的鼻尖。对术前和至少 1 年随访的鼻轴偏斜变量进行摄影比较，并在 1 年随访时对患者进行自我评估问卷调查。术前平均鼻尖偏斜为 6.59°（±3.1°），术后为 1.56°（±0.26°）（ < 0.05）。术前和术后偏斜差异的范围为 2.7°至 15.1°，平均差异为 6.1°（±3.21°）。在 84 例患者中，47 例（55.95%）非常满意，33 例（39.28%）满意，4 例（4.76%）不满意手术结果并需要再次手术。在作者手中，单侧中断技术（外侧穹隆覆盖或单侧穹隆截断）是一种可行的选择，可以恢复鼻尖的对称性。这些技术在患者中获得了高满意度，术后即刻可见可靠且可重复的对称性，且随着时间的推移稳定（术后 1 年随访）。
