Lu Ting-Chen, Mohammed Shadad M, Liao Han-Tsung
Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
College of Medicine, Chang Gung University, Taoyuan, Taiwan.
J Craniofac Surg. 2023;34(1):272-278. doi: 10.1097/SCS.0000000000008871. Epub 2022 Aug 11.
Saddle nose deformity following naso-orbital ethmoidal (NOE) fractures remain a challenging problem for the reconstructive surgeon. Early reduction and internal fixation allow for fracture stabilization but is unable to address the problem of the depressed nasal dorsum, especially after soft tissue shrinkage. The aim of this study is to evaluate the outcome of primary rhinoplasty in patients with NOE fractures.
From 2016 to 2019, 9 patients presented to our department with NOE fractures complicated by saddle nose deformity underwent primary nasal reconstruction at the time of their fracture fixation. Life size (1:1) frontal and lateral postoperative photographs were taken. Three objective measurements were made, including the nasofrontal angle, tip projection, and radix projection. These measurements were compared between normal persons (group 1), preoperative patients (group 2), and postoperative patients (group 3). Nose aesthetic assessment was carried out via a panel assessment using a Visual Analog Scale of 5. Patient satisfaction was further assessed subjectively by the patient themselves using the Visual Analog Scale.
When comparing group 3 to 2, a significant reduction in the nasofrontal angles was found with an accompanying increase in the radix and tip projection ( P <0.05). No statistical significance between normal persons and postprimary rhinoplasty patients was noted between groups 1 and 3. Average patient satisfaction scored 3.86±1.07 compared with 3.63±0.84 by laypersons and 4±0.77 by specialists' panel.
Primary nasal reconstruction may be an alternative method for achieving optimum results following NOE fractures preventing the development of secondary saddle nose deformity with a shortened nose which may potentially be more difficult to correct.
鼻眶筛（NOE）骨折后鞍鼻畸形仍然是重建外科医生面临的一个具有挑战性的问题。早期复位和内固定可实现骨折稳定，但无法解决鼻背凹陷问题，尤其是在软组织收缩后。本研究的目的是评估NOE骨折患者一期鼻整形的效果。
2016年至2019年，9例因NOE骨折并发鞍鼻畸形前来我院就诊的患者在骨折固定时接受了一期鼻重建。拍摄术后与实物大小相同（1:1）的正面和侧面照片。进行了三项客观测量，包括鼻额角、鼻尖突出度和鼻根突出度。对正常人群（第1组）、术前患者（第2组）和术后患者（第3组）的这些测量结果进行了比较。通过使用5分视觉模拟量表的专家小组评估进行鼻部美学评估。患者满意度由患者本人使用视觉模拟量表进行主观进一步评估。
将第3组与第2组比较时，发现鼻额角显著减小，同时鼻根和鼻尖突出度增加（P<0.05）。第1组和第3组之间，正常人与一期鼻整形术后患者之间未发现统计学差异。患者平均满意度评分为3.86±1.07，外行评分为3.63±0.84，专家小组评分为4±0.77。
一期鼻重建可能是一种替代方法，可在NOE骨折后取得最佳效果，防止继发性鞍鼻畸形的发生，而继发性鞍鼻畸形伴有鼻缩短，可能更难矫正。
