From the RinoIstanbul Facial Plastic Surgery Clinic.
Dallas Plastic Surgery Institute.
Plast Reconstr Surg. 2024 May 1;153(5):922e-931e. doi: 10.1097/PRS.0000000000010851. Epub 2023 Jun 20.
Preservation rhinoplasty is a growing area of interest among rhinoplasty surgeons. Dorsal preservation-a tenet of preservation rhinoplasty-is predicated on maintaining the integrity of the nasal midvault and effecting aesthetic change through alterations to the bony nasal pyramid and underlying septum. A challenge that is unique to dorsal preservation is the phenomenon of hump recurrence, because of the existence of anatomical blocking points. Blocking points are resistant tensile forces that either impede dorsal lowering intraoperatively or push the dorsum back to its native convexity over time. Five anatomical blocking points have previously been described, which the authors expand on and include an additional two. The seven anatomical blocking points are as follows: the cartilaginous septum, the perpendicular plate of the ethmoid, the lateral osteotomy site, the Webster triangle, the internal mucoperiosteum of the maxillary bone, the medial canthal ligament, and the lateral keystone area. It is critical that the surgeon be aware of the particular blocking points relevant to his or her chosen technique, and to appropriately and methodically address them to ensure consistent long-term results.
保存性鼻整形术是鼻整形医师越来越感兴趣的领域。背侧保存术——保存性鼻整形术的一个原则——基于维持鼻中部穹窿的完整性，并通过改变骨性鼻锥体和鼻中隔下部来实现美学改变。背侧保存术所特有的一个挑战是驼峰复发的现象，这是由于存在解剖学阻挡点。阻挡点是抵抗张力的力量，它们要么在手术中阻碍背侧降低，要么随着时间的推移将背侧推回到其原始的凸度。先前已经描述了五个解剖学阻挡点，作者对此进行了扩展，并增加了另外两个。这七个解剖学阻挡点如下：鼻中隔软骨、筛骨垂直板、外侧截骨部位、Webster 三角、上颌骨的内黏膜骨膜、内眦韧带和外侧基石区域。对于外科医生来说，了解与他或她选择的技术相关的特定阻挡点并适当地、系统地解决这些问题以确保长期的一致效果至关重要。
