Constantinides M S, Adamson P A, Cole P
Department of Otolaryngology, New York, NY, University Medical Center, USA.
Arch Otolaryngol Head Neck Surg. 1996 Jan;122(1):41-5. doi: 10.1001/archotol.1996.01890130035005.
To determine if elective cosmetic septorhinoplasty impacts on nasal air flow resistance over the long-term.
Case series. Mean postoperative follow-up period was 41.5 months (range, 16 to 77 months).
A consecutive sample of 200 patients having undergone cosmetic open septorhinoplasty by one of us (P.A.A.) before July 1992 were contacted by telephone; 50 agreed to participate, and 27 actually participated in the study.
Open cosmetic septorhinoplasty performed by one of us (P.A.A.).
Comparison of preoperative and postoperative nasal resistance values by headout body displacement plethysmography; correlation of preoperative and postoperative nasal valve anatomy with nasal resistance values; and correlation of postoperative nasal resistance values with subjective evaluation of nasal air flow as reported on a 10-point analogue scale.
Of the 27 patients, 10 had normal preoperative nasal resistance values and 17 had elevated resistance values. Preoperative Normal Group: Four of the 10 patients' mean resistance values exceeded normal limits postoperatively. One of these four patients reported subjective nasal obstruction. Preoperative Abnormal Group: Of the 17 patients, surgery resulted in normal resistance values postoperatively in six, decreased but still above normal resistance values in eight, and no decrease in postoperative resistance values in three.
(1) Patients with normal nasal resistance values may suffer long-term, asymptomatic increase in nasal resistance values after cosmetic open septorhinoplasty, often with no quantifiable change at the nasal valve. (2) Patients with elevated nasal resistance measurements generally improve with open septorhinoplasty. Patients with isolated septal deformities improve with septoplasty. Patients with upper lateral cartilage collapse improve with spreader grafts. The lasting objective improvement on the nasal valve using spreader grafts is reported herein for the first time. (3) Subjective estimations of nasal patency do not correlate well with objective measures of patency, namely nasal resistance measurements. (4) Cosmetic septorhinoplasty can alter nasal patency. Continued care must be exercised when manipulating the nasal framework for cosmetic purposes, as slight changes to the nasal valve may result in significant alterations in nasal air flow resistance.
确定择期美容性鼻中隔鼻成形术对长期鼻气流阻力的影响。
病例系列研究。术后平均随访期为41.5个月（范围16至77个月）。
对1992年7月前由我们其中一人（P.A.A.）进行美容性开放式鼻中隔鼻成形术的200例患者进行连续抽样，通过电话联系；50例同意参与，27例实际参与了研究。
由我们其中一人（P.A.A.）进行开放式美容性鼻中隔鼻成形术。
通过头位体动体积描记法比较术前和术后鼻阻力值；术前和术后鼻瓣解剖结构与鼻阻力值的相关性；以及术后鼻阻力值与用10分模拟量表报告的鼻气流主观评估的相关性。
27例患者中，10例术前鼻阻力值正常，17例阻力值升高。术前正常组：10例患者中有4例术后平均阻力值超过正常范围。这4例患者中有1例报告有主观鼻阻塞。术前异常组：17例患者中，术后6例阻力值恢复正常，8例降低但仍高于正常阻力值，3例术后阻力值未降低。
（1）鼻阻力值正常的患者在美容性开放式鼻中隔鼻成形术后可能会长期无症状地出现鼻阻力值增加，鼻瓣通常无可量化的变化。（2）鼻阻力测量值升高的患者一般通过开放式鼻中隔鼻成形术有所改善。单纯鼻中隔畸形患者通过鼻中隔成形术改善。上外侧软骨塌陷患者通过撑开移植片改善。本文首次报道了使用撑开移植片对鼻瓣的持久客观改善。（3）鼻通畅的主观估计与通畅的客观测量指标即鼻阻力测量值相关性不佳。（4）美容性鼻中隔鼻成形术可改变鼻通畅度。出于美容目的操作鼻支架时必须持续谨慎，因为鼻瓣的轻微变化可能导致鼻气流阻力的显著改变。
