Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, 67 Burton Street, Darlinghurst, Sydney, NSW 2010, Australia.
Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, 67 Burton Street, Darlinghurst, Sydney, NSW 2010, Australia.
J Plast Reconstr Aesthet Surg. 2022 Jul;75(7):2352-2358. doi: 10.1016/j.bjps.2022.02.017. Epub 2022 Feb 24.
Different techniques exist to provide tip support in rhinoplasty. There is little evidence to provide a consensus on the most effective choice.
Evaluating columellar strut graft (CSG) and septal extension grafts (SEG) for their influence on airway function, patient satisfaction and tip support.
DESIGN, SETTINGS AND PARTICIPANTS: A retrospective cohort study was undertaken on 165 adult patients who underwent open rhinoplasty with either a CSG or SEG, from February 2012 to August 2019 in a single tertiary facial-plastic practice in Sydney, Australia. Operations were for both cosmetic and functional indications, and both primary and revision cases were assessed. Airway testing and patient-reported outcomes (PROMs) were performed preoperatively and at least 6 months following the procedure. Photographic tip analysis was taken from approximately 4 and 12-month postoperative photographs.
Nasal peak inspiratory flow (NPIF) and total nasal airway resistance (NAR) were the primary airway functional outcomes. The primary PROMs analysed were a visual analogue scale (VAS) for nasal obstruction and 13-point Likert scale for global cosmesis, the Nose Outcome Symptom Evaluation (NOSE), and the nasal obstruction score. Tip support was determined by the nasolabial angle (NLA) and Simon's ratio as assessed by Rhinobase developed by Apaydin et al. on lateral Frankfort plane photographs. Data normalised as an improvement over preoperative baseline, accounting for individual variability.
A total of 165 patients was assessed (35.2 ± 12.9 yrs, 72% female), 100 (61%) of which received SEG. There were similar nasal airway assessments between CSG and SEG groups, with ΔNPIF (20.0 ± 42.1 L/min v 19.9 ± 44.9 L/min, p = 0.983) and Δ "obstructed" NAR (-1.13 ± 1.90 v -1.02 ± 4.33 Pa/cm3/s, p = 0.849). Amongst PROMs, a greater cosmetic outcome was seen in the SEG group (7.20 ± 2.97 v 5.69 ± 3.45, p < 0.01) with all other assessments similar between CSG and SEG techniques. Photographic analysis of tip projection showed reduced NLA distortion in the SEG.
While greater patient-perceived cosmesis was seen in patients with a SEG, there were similar airflow and patient-reported nasal function between groups. Photographic analysis of tip projection showed SEG patients additionally benefited from less NLA distortion and greater tip maintenance.
在鼻整形术中，存在多种提供鼻尖支撑的技术。目前几乎没有证据可以达成最有效选择的共识。
评估鼻中隔延长移植物（SEG）和鼻中隔支撑移植物（CSG）在气道功能、患者满意度和鼻尖支撑方面的影响。
设计、地点和参与者：这是一项回顾性队列研究，纳入了 2012 年 2 月至 2019 年 8 月在澳大利亚悉尼的一家单一的三级面部整形机构中接受开放式鼻整形术的 165 例成年患者，这些患者接受了 CSG 或 SEG。手术的适应证包括美容和功能，评估了原发性和复发性病例。在术前和术后至少 6 个月进行气道测试和患者报告的结果（PROM）。从术后大约 4 个月和 12 个月的照片中获取鼻尖分析的照片。
鼻峰吸气流量（NPIF）和总鼻气道阻力（NAR）是主要的气道功能结局。分析的主要 PROM 是鼻腔阻塞的视觉模拟量表（VAS）和全球美容的 13 点 Likert 量表，鼻结局症状评估（NOSE）和鼻阻塞评分。通过 Apaydin 等人开发的 Rhinobase 基于侧法兰克福平面照片评估鼻尖支撑，使用鼻唇角（NLA）和西蒙比值来确定。数据归一化为与术前基线相比的改善，考虑到个体变异性。
共评估了 165 例患者（35.2±12.9 岁，72%为女性），其中 100 例（61%）接受了 SEG。CSG 和 SEG 组的鼻腔气道评估相似，NPIF 的改善（20.0±42.1 L/min 比 19.9±44.9 L/min，p=0.983）和“阻塞”NAR 的改善（-1.13±1.90 比 -1.02±4.33 Pa/cm3/s，p=0.849）。在 PROM 中，SEG 组的美容效果更好（7.20±2.97 比 5.69±3.45，p<0.01），而 CSG 和 SEG 技术之间的其他评估结果相似。鼻尖投影的影像学分析显示，SEG 患者的 NLA 扭曲程度更低。
尽管 SEG 患者的患者感知美容效果更好，但两组的气流和患者报告的鼻腔功能相似。鼻尖投影的影像学分析显示，SEG 患者还受益于更低的 NLA 扭曲和更大的鼻尖维持。
