Rohrich R J, Minoli J J, Adams W P, Hollier L H
Department of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical Center, Dallas, USA.
Plast Reconstr Surg. 1997 Apr;99(5):1309-12; discussion 1313. doi: 10.1097/00006534-199704001-00015.
A precise and reproducible lateral osteotomy is a requirement for successful rhinoplasty. Two basic techniques have evolved: the external perforated method and the internal continuous method. The literature supporting the external perforated technique maintains that it contributes to a controlled, stable fracture and produces less nasal airway narrowing, hemorrhage, edema, and ecchymosis; however, the continuous internal method is used by many rhinoplasty surgeons. Our study was designed to compare the two techniques in the fresh cadaver nose using a blinded endoscopic evaluation of the nasal mucosa after the osteotomies were performed by one of these two techniques. Nineteen fresh cadaver heads had an external perforated lateral osteotomy performed on one side and an internal continuous lateral osteotomy performed on the alternate side by an investigator with experience in the use of both osteotomies. In a blinded fashion, four different investigators used nasal endoscopy to detect mucosal perforations and bony irregularities. Eleven percent of the perforated osteotomies resulted in mucosal tearing as opposed to 74 percent of the continuous osteotomies (p < 0.001). This anatomic study confirms our clinical experience that the external perforated osteotomy results in a more controlled fracture with less intranasal trauma and can minimize the associated morbidity (hemorrhage, edema, and ecchymosis) in the rhinoplasty patient.
精确且可重复的外侧截骨术是成功鼻整形术的一项要求。已发展出两种基本技术：外部穿孔法和内部连续法。支持外部穿孔技术的文献认为，它有助于实现可控、稳定的骨折，且导致鼻气道狭窄、出血、水肿和瘀斑的情况较少；然而，许多鼻整形外科医生使用的是连续内部法。我们的研究旨在通过在新鲜尸体鼻上采用这两种技术之一进行截骨术后对鼻黏膜进行盲法内镜评估，来比较这两种技术。19个新鲜尸体头部，由一位具备两种截骨术使用经验的研究者在一侧进行外部穿孔外侧截骨术，在另一侧进行内部连续外侧截骨术。以盲法形式，四名不同的研究者使用鼻内镜检查来检测黏膜穿孔和骨质不规则情况。穿孔截骨术导致黏膜撕裂的比例为11%，而连续截骨术为74%（p < 0.001）。这项解剖学研究证实了我们的临床经验，即外部穿孔截骨术能实现更可控的骨折，鼻内创伤更小，并可将鼻整形术患者的相关发病率（出血、水肿和瘀斑）降至最低。
