Öztürk Güncel
From the Nisantasi University, İstanbul, Turkey; and Private Practice, İstanbul, Turkey.
Ann Plast Surg. 2025 Jan 1;94(1):10-16. doi: 10.1097/SAP.0000000000004152. Epub 2024 Nov 12.
Grafts and flaps play significant roles in rhinoplasty procedures, while spreader grafts are commonly used. Spreader grafts are placed into submucosal pockets between the upper lateral cartilage and nasal septum. Occurrence of deviation can be seen on nondeviated noses after let-down or push-down methods are performed as the part of the upper septum that has been let-down may cause pressure on the lower septum and that results in deviation. In the present study, the author aimed to demonstrate the benefits of using a proximal intact spreader graft to support the nondeviated nasal septum or to correct the deviated septum in patients undergoing dorsal preservation rhinoplasty. In deviated noses, the upper septum is brought down to the opposite side of the deviation, and a proximal intact spreader graft is placed between the upper and lower septum to correct the deviation and make the dorsum nondeviated. This technique is suitable for patients with a slight to moderately deviated caudal part of the septum. It is unsuitable for patients with severe, cross, or S-shaped deviation. This technique aims to preserve the condition of the nondeviated nose and convert it into a nondeviated state in the let-down technique. The combination of proximal intact spreader graft and dorsal preservation rhinoplasty techniques effectively addresses dorsal hump and dorsal deviation deformities, enhances upper lateral cartilage concavity, prevents W-ASA segment collapse, and both prevents and improves internal nasal valve collapse. The data of patients who underwent dorsal hump reduction with the let-down technique were screened. According to inclusion and exclusion criteria, 95 patients were included in the study (68 females and 27 males). The ROE score before the operation was 51.5. After 12 months, it was found to be 91.5 points, and the change in the ROE median score was significant ( P < 0.001). This new proximal intact spreader graft method presents a suitable approach for surgeons to prevent any let-down-induced deviation problems that may occur after the procedure and to correct the present deviation. It will also lead to better cosmetic and functional outcomes for patients who have hump deformity.
移植物和皮瓣在鼻整形手术中发挥着重要作用，其中撑开移植物应用广泛。撑开移植物置于上外侧软骨与鼻中隔之间的黏膜下间隙。在采用下拉或下压方法后，原本鼻中隔无偏曲的鼻子也可能出现偏曲，这是因为下拉部分的上鼻中隔可能会对下鼻中隔产生压力，进而导致偏曲。在本研究中，作者旨在证明在进行保留鼻背的鼻整形手术时，使用近端完整的撑开移植物来支撑无偏曲的鼻中隔或矫正偏曲鼻中隔的益处。对于鼻中隔偏曲的鼻子，将上鼻中隔下拉至偏曲的对侧，然后在上、下鼻中隔之间放置近端完整的撑开移植物，以矫正偏曲并使鼻背变直。该技术适用于鼻中隔尾端轻度至中度偏曲的患者，不适用于严重、交叉或S形偏曲的患者。此技术旨在保持无偏曲鼻子的状态，并在下拉技术中使其转变为无偏曲状态。近端完整撑开移植物与保留鼻背鼻整形技术相结合，能有效解决鼻背驼峰和鼻背偏曲畸形，增强上外侧软骨凹陷度，防止W - ASA段塌陷，同时预防和改善鼻内瓣膜塌陷。筛选了采用下拉技术进行鼻背驼峰矫正的患者数据。根据纳入和排除标准，95例患者纳入本研究（68例女性和27例男性）。术前ROE评分为51.5分。12个月后，发现评分为91.5分，ROE中位数评分变化显著（P < 0.001）。这种新的近端完整撑开移植物方法为外科医生提供了一种合适的途径，可预防手术后可能出现的任何下拉引起的偏曲问题，并矫正现有的偏曲。对于有驼峰畸形的患者，这也将带来更好的美容和功能效果。
