Santagata Mario, Boschetti Ciro Emiliano, Chagas-Junior Otacilio Luiz, Gualdi Alessandro, Rugge Luigi, Tartaro Gianpaolo, Chirico Fabrizio
Multidisciplinary Department of Medical-Surgical and Dental Specialities, Maxillofacial Surgery Unit, AOU University of Campania "Luigi Vanvitelli," Naples, Italy.
Department of Oral and Maxillofacial Surgery, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil.
Facial Plast Surg. 2025 Aug;41(4):465-471. doi: 10.1055/a-2413-3783. Epub 2024 Sep 11.
Current concepts in orthognathic surgery focus on not just rectifying dentoskeletal irregularities but also improving facial aesthetic and function. In this respect, nasal reshaping holds extraordinary significance in determining surgery effectiveness and patient satisfaction. Facial preoperative evaluations emphasize the paramount functional and aesthetic impacts of caudal septum in tip reshaping. Deviations in this anatomical subunit could lead to significant nasal obstructions and aesthetic changes as twisted nasal tip, affecting projection, rotation, and columellar-alar relationship. These considerations are essential in orthofacial surgery, as maxillary movements might exacerbate or worsen preexisting nasal tip deformity. In this paper, we aim to describe a novel and innovative minimally invasive approach presenting a detailed account of a rhinoseptoplasty in which the entire nasal tip reshaping procedure was performed intraorally during orthognathic surgery. The technique focused on achieving optimal nasal tip projection and rotation, centering, and stabilization through strategic maneuvers such as incremental dissection of maxillary spine chondroperiosteal junction, superoposterior strut preservation, vertical and caudal septum resection, and anterior nasal spine tip support. Techniques including subnasal drilling and septal stabilization suture are detailed. Specific attention is given to addressing deficiencies in posterior septal angle and labiocolumellar relationship. Postoperative care is described and subjective evaluations were performed to assess patient and surgeon satisfaction with facial symmetry and overall aesthetic improvements. In our experience, the described approach offers valuable surgical finesse to orthognathic surgery, effectively targeting caudal septum deviations and nasal tip droopy. Its unique perspective enhances both functional and aesthetic results, particularly in the context of profiloplasty. No external nasal incision was performed and the totality of nasal tip reshaping was scarless and performed through an intraoral approach. Surgical precision in execution of this novel and tailored surgical approach has been shown to have a profound impact for enhancing outcomes of orthofacial surgery procedure.
正颌外科的当前理念不仅关注矫正牙颌面畸形，还注重改善面部美观和功能。在这方面，鼻整形在决定手术效果和患者满意度方面具有非凡的意义。面部术前评估强调鼻中隔尾端在鼻尖整形中至关重要的功能和美学影响。这个解剖亚单位的偏差可能导致严重的鼻阻塞和美学改变，如鼻尖扭曲，影响突出度、旋转度以及鼻小柱与鼻翼的关系。这些考量在正颌面部手术中至关重要，因为上颌骨移动可能会加重或恶化原有的鼻尖畸形。在本文中，我们旨在描述一种新颖且创新的微创方法，并详细介绍一种鼻中隔成形术，其中整个鼻尖整形手术是在正颌手术期间经口内进行的。该技术专注于通过对上颌棘软骨膜交界处进行渐进性剥离、保留后上支柱、垂直和鼻中隔尾端切除以及前鼻棘鼻尖支撑等策略性操作，实现最佳的鼻尖突出度、旋转度、居中及稳定。详细介绍了包括鼻下钻孔和鼻中隔稳定缝合在内的技术。特别关注解决鼻中隔后角和唇鼻小柱关系的不足。描述了术后护理，并进行主观评估以评估患者和外科医生对面部对称性和整体美学改善的满意度。根据我们的经验，所描述的方法为正颌手术提供了有价值的手术技巧，有效地针对鼻中隔尾端偏差和鼻尖下垂问题。其独特的视角增强了功能和美学效果，特别是在轮廓整形方面。未进行鼻外切口，整个鼻尖整形无痕且通过口内入路完成。这种新颖且量身定制的手术方法在执行过程中的手术精准度已被证明对提高正颌面部手术效果有深远影响。
