Adamson P A, McGraw-Wall B L, Morrow T A, Constantinides M S
Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Ontario.
Arch Otolaryngol Head Neck Surg. 1994 Apr;120(4):373-80. doi: 10.1001/archotol.1994.01880280003001.
A new modification of vertical dome division (VDD) in rhinoplasty using cartilage overlap and suturing to reestablish the integrity of the alar cartilages is analyzed and compared with the more standard technique of cartilage resection and suturing.
Retrospective before-and-after trial.
Private patients of one of the authors (P.A.A.) undergoing surgery in the Department of Otolaryngology of the University of Toronto (Ontario).
A consecutive sample of 116 patients having undergone open rhinoplasty with VDD between 1981 and 1990 were evaluated. Seventy-five had VDD before 1987, when a cartilage resection and suturing technique was used (P.A.A.); 41 had their surgery after 1987, with the cartilage overlap and suturing technique. All patients were available for follow-up. The mean follow-up time was 15.2 months, with a range of 6 to 63 months.
Indications for VDD were lobule asymmetry (47%), retrodisplacement (24%), wide domal arch (22%), hanging infratip lobule (6%), and rotation (1%). Prior to 1987, VDD was performed by dividing the alar cartilages, resecting certain portions, and then suturing the cartilages together again to recreate the alar margin. After 1987, VDD was revised by overlapping the portions of cartilage that would have been previously resected and suturing the overlapping portions to recreate the alar margin.
Patient satisfaction; physician evaluation; physical examination; blinded comparison of preoperative and postoperative photographs; need for revision surgery.
Overall, six (5.0%) of 116 patients required revision surgery or had photographic and/or physical evidence of nasal tip irregularities. Three (4.0%) of 75 patients from the cartilage excision group and one (2.4%) of 41 patients from the overlap group required revision surgery. The other two patients, one in each group, had minor tip irregularities not requiring surgery. The tip irregularities were due to nasal bossae in four patients and lobule asymmetries in two. There was no alar notching or lower nasal third pinching. Tip irregularities were three times as likely to occur in patients presenting for revision rhinoplasty than in those for primary rhinoplasty.
Vertical dome division is a powerful tool in rhinoplasty, allowing for complex manipulations of alar cartilages to selectively enhance projection, rotation, and domal arch width. It also allows for correction of lobule asymmetries and elongation or hanging of the infratip lobule. The cartilage overlap technique reduces the occurrence of several common postoperative tip abnormalities and lowers the need for revision surgery when compared with cartilage resection VDD. The reported results can only be considered trends, as sample sizes in the series were too small to allow for statistical significance.
分析一种鼻整形术中垂直穹窿部划分（VDD）的新改良方法，即使用软骨重叠和缝合来重建鼻翼软骨的完整性，并与更标准的软骨切除和缝合技术进行比较。
回顾性前后对照试验。
安大略省多伦多大学耳鼻喉科，一位作者（P.A.A.）的私人患者。
对1981年至1990年间接受开放性鼻整形术并采用VDD的116例患者进行连续抽样评估。75例在1987年之前接受VDD，当时采用软骨切除和缝合技术（P.A.A.）；41例在1987年之后接受手术，采用软骨重叠和缝合技术。所有患者均可供随访。平均随访时间为15.2个月，范围为6至63个月。
VDD的适应症包括小叶不对称（47%）、后移位（24%）、宽穹窿弓（22%）、鼻尖小叶下垂（6%）和旋转（1%）。1987年之前，VDD通过分割鼻翼软骨、切除某些部分，然后再次将软骨缝合在一起以重建鼻翼边缘来进行。1987年之后，VDD通过将之前会被切除的软骨部分重叠并缝合重叠部分来重建鼻翼边缘。
患者满意度；医生评估；体格检查；术前和术后照片的盲法比较；修复手术的需求。
总体而言，116例患者中有6例（5.0%）需要进行修复手术，或有鼻尖不规则的照片和/或体格检查证据。软骨切除组的75例患者中有3例（4.0%），重叠组的41例患者中有1例（2.4%）需要进行修复手术。另外两名患者，每组各一名，有轻微的鼻尖不规则，无需手术。鼻尖不规则是由四名患者的鼻丘和两名患者的小叶不对称引起的。没有鼻翼切迹或鼻下部捏痕。修复性鼻整形术患者出现鼻尖不规则的可能性是初次鼻整形术患者的三倍。
垂直穹窿部划分是鼻整形术中一种强大的工具，可对鼻翼软骨进行复杂操作，以选择性地增强突出度、旋转度和穹窿弓宽度。它还可用于矫正小叶不对称以及鼻尖小叶的伸长或下垂。与软骨切除VDD相比，软骨重叠技术减少了几种常见的术后鼻尖异常的发生，并降低了修复手术的需求。由于该系列中的样本量太小，无法得出统计学意义，因此所报告的结果只能视为趋势。
