Department of Otorhinolaryngology, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia.
Institute of Medical Sciences, Canterbury Christ Church University, Kent, United Kingdom.
Facial Plast Surg. 2024 Feb;40(1):52-60. doi: 10.1055/a-2047-7179. Epub 2023 Mar 6.
The role of septorhinoplasty for adequate correction of deviated nose is well documented, but the rationales and patterns for recurrences after proper rhinoplasty remain unclear. There has also been little attention given to the influence of nasal musculatures on the stability of nasal structures after septorhinoplasty. The aim of this article is to propose our nasal muscle imbalance theory, which may explain the potential reason for redeviation of the noses in the initial period after septorhinoplasty. We postulate that in a chronically deviated nose, the nasal muscles on the convex side will be stretched and develop hypertrophy after prolonged period of increased contractile activity. On the contrary, the nasal muscles on the concave side will undergo atrophy due to reduced load requirement. In the initial period of recovery after a septorhinoplasty to bring the nose back to midline, this muscle imbalance is still uncorrected with unequal pulling forces on the nasal structure because the stronger nasal muscles on the previously convex side is still hypertrophied and exert stronger forces compared with the previously concave side, therefore increasing the risk of redeviation of the nose back to the preoperative side until muscle atrophy occurs in the convex side and a balanced nasal muscle pull is achieved. We believe that postseptorhinoplasty botulinum toxin injections can be used as an adjunct in rhinoplasty surgery to effectively block the pulling actions of the stronger or overacting nasal muscles by speeding up the atrophy process while allowing patient's nose to heal and stabilize in the desired position. However, further studies to objectively confirm this hypothesis is required, which include comparing topographic measurements, imaging and electromyography signals before and after injections in postseptorhinoplasty patients. The authors have already planned a multicenter study to further evaluate this theory.
鼻中隔成形术在纠正偏曲鼻方面的作用已得到充分证实，但在适当的鼻整形术后复发的原因和模式仍不清楚。对于鼻肌肉对鼻中隔成形术后鼻结构稳定性的影响，也很少关注。本文旨在提出我们的鼻肌失衡理论，该理论可能解释了鼻中隔成形术后初期鼻子再次偏曲的潜在原因。我们假设，在慢性偏曲的鼻子中，长期增加的收缩活动会导致凸侧的鼻肌被拉伸并发生肥大。相反，由于负载要求减少，凹侧的鼻肌会发生萎缩。在鼻中隔成形术后恢复的初期，为了使鼻子恢复到中线，由于鼻结构上的不平衡拉力，这种肌肉失衡仍然没有得到纠正，因为以前凸侧的更强壮的鼻肌仍然肥大，并比以前凹侧的鼻肌产生更强的力，因此增加了鼻子重新偏回到术前侧的风险，直到凸侧的鼻肌发生萎缩并达到平衡的鼻肌拉力。我们认为，鼻中隔成形术后肉毒毒素注射可以作为鼻整形手术的辅助手段，通过加速萎缩过程，有效阻断较强或过度活跃的鼻肌的牵拉作用，同时允许患者的鼻子在理想位置愈合和稳定。然而，需要进一步的研究来客观证实这一假设，包括比较鼻中隔成形术后患者注射前后的表面测量、影像学和肌电图信号。作者已经计划进行一项多中心研究来进一步评估这一理论。
