Adamson J E
Ann Plast Surg. 1987 Feb;18(2):114-21. doi: 10.1097/00000637-198702000-00004.
The anatomy and functional physiology of the internal nasal valve and the potential problems that may develop with it during rhinoplasty are discussed. The operative maneuvers that may compromise the nasal valve serve as a basis for explaining a treatment approach. Treatment primarily deals with the problems generated by scar contraction, excision of lining and cartilage, and malposition of various nasal parts. In rhinoplasty, one must preserve the integrity of the internal nasal valve by preventing scar constriction and maintaining cartilage support. All intranasal incisions should be closed carefully with meticulous suturing. The surgeon should strive to preserve the medial attachment of the upper lateral cartilage to the septum. The caudal border of the upper lateral cartilage should not be trimmed. Lining should not be excised at the level of the internal valve, or distally. If scar constriction occurs or cartilage instability develops, the goal of treatment is restoration of valve function by excision of all scar tissue, repositioning the cartilage framework, and reconstruction using full-thickness and composite skin-cartilage grafts. The value of the intracartilaginous incision in preventing injury to the internal nasal valve is emphasized. Many of the established procedures in rhinoplasty that may endanger the nasal valve are discussed.
本文讨论了鼻内瓣膜的解剖结构和功能生理学，以及隆鼻手术过程中可能出现的相关潜在问题。可能损害鼻瓣膜的手术操作是解释一种治疗方法的基础。治疗主要针对瘢痕挛缩、衬里和软骨切除以及鼻各部分位置异常所产生的问题。在隆鼻手术中，必须通过防止瘢痕收缩和维持软骨支撑来保持鼻内瓣膜的完整性。所有鼻内切口都应仔细缝合。外科医生应努力保留上外侧软骨与鼻中隔的内侧附着。上外侧软骨的尾缘不应修剪。在鼻内瓣膜水平或其远端不应切除衬里。如果发生瘢痕挛缩或软骨不稳定，治疗的目标是通过切除所有瘢痕组织、重新定位软骨框架以及使用全厚和复合皮肤软骨移植物进行重建来恢复瓣膜功能。强调了软骨内切口在预防鼻内瓣膜损伤方面的价值。文中还讨论了隆鼻术中许多可能危及鼻瓣膜的既定手术方法。
