Shi Yanyan, Tan Xiaoyan, Sun Haiyang, Char Sydney
From the Hangzhou Plastic Surgery Hospital, Hangzhou, Zhejiang, China.
Ann Plast Surg. 2021 Mar 1;86(3S Suppl 2):S189-S193. doi: 10.1097/SAP.0000000000002641.
There has been an increase in use of autologous costal cartilage for nasal tip shaping material. However, there are deficiencies in using this plastic material, such as a hard nasal tip, poor nasal tip elasticity and mobility postoperatively, and some nasal tip skin thinning that allows the shape of the cartilage grafts to be felt on the surface of the nasal tip skin. To address these problems, we have combined autologous nasal septum cartilage and conchal cartilage as nasal tip graft materials, which achieve a natural shape and realistic touch postoperatively.
From January 2017 to September 2019, a total of 47 patients with nasal septal cartilage combined with conchal cartilage transplantation for nasal tip plasty were screened for a retrospective study. They were followed up and evaluated for 6 to 25 months postoperatively. The operation was performed through an incision in the nose. During the operation, a piece of septal cartilage was cut to make a columella strut. Using one side of the cavitas conchae and cymba conchae cartilage as the graft material, 2 long strips of cartilage were excised for the septum extension graft, and a piece of cap cartilage was transplanted to the top of the nasal tip cartilage scaffold.
The time between the operation and follow-up was greater than 6 months, with the range of follow-up and evaluation being from 6 to 25 months. Forty-six patients were satisfied with the shape of the nose. One patient complained that the nasal tip was round and large after 1 month postoperatively, but after 6 months, he was satisfied with the shape of the nasal tip after daily use of a nasal clip. In one male case, the implant was removed more than 7 months postoperatively because of hematoma and infection secondary to nasal trauma. There were 2 cases of nasal tip numbness, both of which recovered spontaneously after 12 months. After the operation, the shape of the nasal tip was round, no cartilage contour was seen on the surface, no collapse of upper nasal tip, no obvious deviation of the nasal dorsum and columella, and no deformation and displacement of the nasal tip cartilage scaffold. At the 6-month follow-up visit, each patient palpated the nasal tip for evaluation. Most patients felt their nose felt realistic and that they had good nasal tip motion. Only 1 patient felt that the nasal tip and the nasal dorsum were moving together when the tip of the nose was being pushed.
Nasal septum cartilage and conchal cartilage can be combined as a graft material for reconstruction of the nasal tip. This technique uses different characteristics of each of the 2 cartilages to achieve a more realistic and esthetic outcome.
自体肋软骨用于鼻尖塑形材料的使用有所增加。然而，使用这种整形材料存在不足之处，如鼻尖硬、术后鼻尖弹性和活动度差，以及一些鼻尖皮肤变薄，使得软骨移植物的形状在鼻尖皮肤表面可被摸到。为解决这些问题，我们将自体鼻中隔软骨和耳甲软骨联合作为鼻尖移植材料，术后可实现自然的形状和逼真的触感。
2017年1月至2019年9月，共筛选出47例行鼻中隔软骨联合耳甲软骨移植鼻尖整形术的患者进行回顾性研究。术后对他们进行了6至25个月的随访和评估。手术通过鼻内切口进行。术中，切取一片鼻中隔软骨制作鼻小柱支撑。取一侧耳甲腔和耳甲艇软骨作为移植材料，切取2条长条状软骨用于鼻中隔延长移植，并将一片帽状软骨移植到鼻尖软骨支架顶部。
手术至随访时间大于6个月，随访评估时间为6至25个月。46例患者对鼻形满意。1例患者术后1个月抱怨鼻尖圆大，但6个月后，经每日使用鼻夹，他对鼻尖形状感到满意。1例男性患者术后7个多月因鼻外伤继发血肿和感染取出植入物。有2例鼻尖麻木，均在12个月后自行恢复。术后鼻尖形状圆润，表面未见软骨轮廓，鼻尖上部无塌陷，鼻背和鼻小柱无明显偏斜，鼻尖软骨支架无变形和移位。在6个月的随访中，每位患者触摸鼻尖进行评估。大多数患者感觉鼻子触感逼真，鼻尖活动良好。只有1例患者在按压鼻尖时感觉鼻尖和鼻背一起移动。
鼻中隔软骨和耳甲软骨可联合作为鼻尖重建的移植材料。该技术利用这两种软骨各自的特性，实现了更逼真和美观的效果。
