Department of Facial Plastic Surgery, Clinica Mario Ferraz, Campinas, Brazil.
Curso de Medicina, UniCesumar Curso de Medicina, Maringa, Paraná, Brazil.
Facial Plast Surg. 2021 Feb;37(1):45-52. doi: 10.1055/s-0041-1725154. Epub 2021 Mar 14.
Nasal dorsal preservation surgery was described more than 100 years ago, but recently has gained prominence. Our objective is to show the surgical technique, the main indications and counterindications, and the complications. It is a technique that does not cause the detachment of the upper lateral cartilage (ULC) from the nasal septum, and has the main following sequence: preparation of the septum and its resection can be at different levels (high or low, i.e., SPAR [septum pyramidal adjustment and repositioning] A or B); preparation of the pyramid; transversal osteotomy; lateral osteotomy(s); and septopyramidal adjustment. The result is a nose with a lower radix than the original, a deprojection of the nasal dorsum tending to maintain its original shape; an increase in the interalar distance (IAD) and enlargement of the nasal middle ⅓; and loss of projection of the nasal tip and roundness of the nostrils. Thus, the ideal candidate is the one who benefits from such side effects, that is: tension nose, that is, high radix with projected dorsum, projected anterior nasal septal angle (ANSA), narrow middle ⅓, narrow IAD, thin nostrils and straight perpendicular plate of the ethmoid (PPE), and, depending on the characteristics, the deviated nose. The counterindications are low radix, irregularities in the nasal dorsum, ANSA lower than rhinion, and a wide middle ⅓. And the main stigmas are: a nose with a very low radix, middle ⅓ enlarged, residual hump, and saddling of the supratip area. Other issues of this technique are: the shape of the radix; the need or not to remove PPE; wide dorsum; irregular dorsum; ANSA lower than rhinion; weak cartilages; long nasal bone; deviated PPE; and obsessive patient. We conclude that this is a great technique for noses with characteristics suitable to it; care must be taken with the stigmas it can cause.
鼻背保存手术早在 100 多年前就有描述，但最近才得到重视。我们的目的是展示手术技术、主要适应证和禁忌证以及并发症。该技术不会导致上外侧软骨（ULC）与鼻中隔分离，其主要步骤如下：鼻中隔准备及其切除术可在不同水平进行（高低水平，即 SPAR[鼻中隔金字塔调整和重新定位]A 或 B）；金字塔准备；横向截骨术；外侧截骨术；鼻中隔-金字塔调整。结果是鼻子的根部比原来低，鼻背突出度降低，趋向于保持原来的形状；内眦间距（IAD）增加，中 1/3 鼻增宽；鼻尖突出度丧失，鼻孔呈圆形。因此，理想的适应证是那些受益于这些副作用的患者，即：张力性鼻，即根部高、鼻背突出、前鼻中隔角（ANSA）突出、中 1/3 狭窄、IAD 狭窄、鼻孔薄、筛骨垂直板（PPE）直，以及根据特征表现为偏斜鼻。禁忌证包括根部低、鼻背不平整、ANSA 低于鼻尖、中 1/3 宽。主要的缺点是：鼻子根部非常低、中 1/3 增宽、残留驼峰、鼻尖区鞍状畸形。该技术的其他问题包括：根部形状；是否需要去除 PPE；宽的鼻背；不平整的鼻背；ANSA 低于鼻尖；软骨薄弱；长鼻骨；偏斜的 PPE；以及过度关注的患者。我们得出结论，对于具有适合该技术特征的鼻子，这是一种很好的技术，但需要注意其可能导致的缺点。
