From the Department of Plastic and Reconstructive Surgery.
Department of General Surgery, Kafrelsheikh University Hospital, Kafr El-Sheikh Egypt.
Ann Plast Surg. 2022 May 1;88(5):480-484. doi: 10.1097/SAP.0000000000003099. Epub 2022 Feb 18.
Nasal osteotomy is a powerful cornerstone step in almost all rhinoplasty procedures and is a major cause of postoperative periorbital ecchymosis and edema after rhinoplasty. Different accesses for osteotomy have been described, the most popular of which is the external perforating and the internal continuous methods. These accesses are blind maneuvers and have some drawbacks such as possible visible scar formation in the percutaneous access or high rate of mucosal tear in the endonasal access. Open sky access osteotomy after wide subperiosteal dissection had been described to overcome those disadvantages. Early postoperative sequelae have not been assessed in the literature after using this access. In the present study, we aim to assess early postoperative sequelae after using this technique in comparison with percutaneous perforating osteotomy.
The study was conducted between November 2017 and January 2021. Forty patients were randomly assigned into 2 equal groups. Group A was subjected to lateral osteotomy by percutaneous perforating method, whereas group B underwent lateral osteotomy by the open sky access technique using a 2-mm curved osteotome. Early postoperative periorbital sequelae were assessed on the second and seventh postoperative days, using the grading system suggested by Kara et al (Plast Reconstr Surg. 1999;104:2213-2218). Mucosal tear was assessed on the second postoperative day using nasal endoscopy after removal of nasal packs.
There was a statistically nonsignificant difference between the studied groups regarding ecchymosis and edema occurring on the second or seventh days. Meanwhile, mucosal tear was significantly less in the open sky access osteotomy group.
Open sky access osteotomy is a safe method for lateral nasal osteotomy with direct visualization of the surgical field. It does not require a skin incision that could lead to a scar formation. It produces less mucosal tear than percutaneous perforating osteotomy. No statistically significant difference is found between both techniques regarding postoperative periorbital ecchymosis and edema on the second and seventh postoperative days.
鼻切开术是几乎所有鼻整形手术的重要基石步骤，也是鼻整形术后眶周瘀斑和水肿的主要原因。已经描述了不同的切开入路，其中最流行的是经皮穿孔和连续内切开法。这些入路是盲目操作，存在一些缺点，如经皮入路可能形成可见的疤痕，或经鼻入路黏膜撕裂的发生率较高。广泛的骨膜下剥离后，采用开阔天空入路切开术可以克服这些缺点。目前，关于使用这种入路后的早期术后后遗症尚未在文献中评估。在本研究中，我们旨在评估与经皮穿孔切开术相比，使用这种技术后的早期术后后遗症。
该研究于 2017 年 11 月至 2021 年 1 月进行。40 名患者被随机分为两组。A 组接受经皮穿孔法的外侧切开术，而 B 组接受开放式天空入路技术的外侧切开术，使用 2 毫米的弯骨刀。在术后第 2 天和第 7 天，使用 Kara 等人提出的分级系统（Plast Reconstr Surg. 1999;104:2213-2218）评估眶周早期术后后遗症。在去除鼻内填塞物后，使用鼻内窥镜评估术后第 2 天的黏膜撕裂情况。
在瘀斑和水肿发生在第 2 天或第 7 天的两组之间，没有统计学上的显著差异。同时，开放式天空入路切开术组的黏膜撕裂明显较少。
开放式天空入路切开术是一种安全的外侧鼻切开术方法，可直接观察手术区域。它不需要导致疤痕形成的皮肤切口。与经皮穿孔切开术相比，它产生的黏膜撕裂更少。在术后第 2 天和第 7 天，两种技术在眶周瘀斑和水肿方面没有统计学上的显著差异。
