Byrd H S, Andochick S, Copit S, Walton K G
Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, USA.
Plast Reconstr Surg. 1997 Sep;100(4):999-1010. doi: 10.1097/00006534-199709001-00026.
Failure to control the projection, shape, and rotation of the nasal tip is a common occurrence among patients with weak lower lateral cartilages. These patients' noses are characterized by a weak midvault, a plunging tip with "Polly beak," and drawn-up alae. The purpose of our study was to identify methods for controlling the position and shape of the nasal tip in these high-risk patients. Twenty patients at risk of losing nasal tip projection were retrospectively identified, and measurements made from their preoperative and postoperative photographs were compared. Loss of tip projection occurred in all but one patient whose columella strut was fixed to the caudal septum. Prompted by these failures, we studied the relationship between the dorsum and tip in cadaveric specimens with and without a supratip break. From our observations, a structural extension of the septum-an anterior septal extension graft-was developed to predictably control this relationship. The clinical application of septal extension grafts in open rhinoplasty was subsequently evaluated in 20 patients who were deemed to be at risk of losing tip projection. Postoperative photographic analysis showed nasal tip projection to be maintained or increased in all but one patient with the use of septal extension grafts. A stable caudal septum is essential to the success of the technique.
对于下外侧软骨薄弱的患者，难以控制鼻尖的突出度、形状和旋转是常见现象。这些患者的鼻子特点是鼻中段薄弱、鼻尖呈“鹦鹉嘴”样下垂以及鼻翼上提。我们研究的目的是确定在这些高风险患者中控制鼻尖位置和形状的方法。回顾性地确定了20例有鼻尖突出度丧失风险的患者，并比较了术前和术后照片的测量结果。除了1例鼻中隔支柱固定于鼻中隔尾侧的患者外，所有患者均出现了鼻尖突出度丧失。受这些失败案例的启发，我们研究了有和没有鼻背断点的尸体标本中鼻背与鼻尖之间的关系。根据我们的观察，开发了一种鼻中隔的结构延伸物——鼻中隔前延伸移植物，以可预测地控制这种关系。随后，在20例被认为有鼻尖突出度丧失风险的患者中评估了鼻中隔延伸移植物在开放式鼻整形术中的临床应用。术后照片分析显示，除1例患者外，使用鼻中隔延伸移植物的所有患者鼻尖突出度得以维持或增加。稳定的鼻中隔尾侧对于该技术的成功至关重要。
