From MySelf Clinic; Dipartimento di Scienze Odontostomatologiche e Maxillo-Facciale, "La Sapienza" Università di Roma; Ortognatica Roma, Casa di Cura "Assunzione di Maria Santissima"; and DeA Center Laser & Plastic Surgery Clinic.
Plast Reconstr Surg. 2021 Jul 1;148(1):66-70. doi: 10.1097/PRS.0000000000008064.
The primary element of a crooked nose is a midline deviation of the nasal pyramid. To date, no surgical strategies have been described as compatible with the philosophy of dorsal preservation. The dorsal preservation technique differs from the Joseph structured rhinoplasty because it preserves both the keystone area and the continuity of the cartilaginous vault. The authors focused on the versatility of the dorsal preservation technique even for the deviated nose, introducing the "Pisa Tower concept."
From January of 2015 to June of 2019, 280 patients diagnosed as having a crooked nose underwent primary septorhinoplasty with dorsal preservation through an asymmetric bony wedge resection and lowering of the bony pyramid onto the frontal process of the maxilla (the let-down osteotomy), in accordance with the Pisa Tower concept. Inclusion criteria were a preoperative computed tomography examination, nasal axis deviation, a complete photographic examination preoperatively, and at least a 1-year follow-up.
The mean nasal axis deviation was 7.62 degrees preoperatively and 1.15 degrees postoperatively (p < 0.05). Of the 84 patients, 47 (55.95 percent) were very satisfied, 33 (39.28 percent) were satisfied, and four (4.76 percent) were unsatisfied with surgical results and required revision surgery.
The authors' opinion is that the association of "swinging door" septoplasty with the Pisa Tower concept can be a valid alterative to other techniques when working with the structured rhinoplasty philosophy in patients with a crooked nose. Although this is only a preliminary study, the decreased use of spreaders graft and less aggressive reconstructive methods look very promising.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
歪鼻的主要特征是鼻锥体的中线偏离。迄今为止，还没有描述任何与保留鼻背理念相兼容的手术策略。背侧保留技术与约瑟夫结构性鼻整形术不同，因为它既保留了 keystone 区域，又保持了软骨穹窿的连续性。作者专注于背侧保留技术的多功能性，即使是针对歪鼻，也引入了“比萨斜塔概念”。
从 2015 年 1 月至 2019 年 6 月，280 例诊断为歪鼻的患者接受了背侧保留的初次鼻中隔成形术，方法是通过不对称的骨性楔形切除术和骨性锥体向下降低到上颌额突（降低截骨术），根据比萨斜塔概念进行。纳入标准为术前计算机断层扫描检查、鼻轴偏斜、术前完整的摄影检查以及至少 1 年的随访。
术前平均鼻轴偏斜为 7.62 度，术后为 1.15 度（p < 0.05）。在 84 例患者中，47 例（55.95%）非常满意，33 例（39.28%）满意，4 例（4.76%）对手术结果不满意，需要再次手术。
作者认为，“摆动门”鼻中隔成形术与比萨斜塔概念的结合，在结构性鼻整形术理念下，为歪鼻患者提供了一种替代其他技术的有效方法。尽管这只是初步研究，但减少使用撑开器移植物和更具侵略性的重建方法看起来非常有前途。
临床问题/证据水平：治疗性，IV。
