Guyuron B
Meridia Health System and Case Western Reserve University, Cleveland, Ohio, USA.
Plast Reconstr Surg. 1998 Apr;101(5):1359-63. doi: 10.1097/00006534-199804050-00035.
The purpose of this combined prospective and retrospective study was to review the abnormalities of the footplates of the medial crura, their surgical correction, and the dynamic changes that result from footplate alteration. Prospectively, measurements of 40 footplates were obtained during 20 consecutive primary rhinoplasties. The distance between the footplates at their most posterocaudal position was measured, along with the thickness, length, and width of the footplates. The shape of the nostrils was also observed and correlated to the form of the footplates. The distance between the footplates ranged from 7.5 to 15 mm, the average being 11.4 mm. The length of the footplates ranged from 4 to 7.5 mm, the average being 5.81 mm. The thickness of the footplates averaged 1.06 mm, ranging from 0.80 to 1.5 mm. The width of the footplates ranged from 2.5 to 7.0 mm, averaging 4.48 mm. In a retrospective review of 295 consecutive rhinoplasties, footplates were altered in 76 cases (25.8 percent). Of these cases, 29 procedures (9.8 percent) were performed to narrow the columella base and to advance the subnasale: on 24 patients (8.1 percent), the goal of this maneuver was to narrow the columella base only; on 5 patients (1.7 percent), the operation was conducted to aid in increasing the tip projection, provide a better foundation for the tip, advance the subnasale caudally, and narrow the alar base. Asymmetry of the columella was corrected in 16 patients (5.4 percent), and footplates were resected primarily to reduce the tip projection in 2 patients (0.7 percent). A detailed analysis of the nasal base will dictate one of the following courses pertaining to footplate alteration. If the patient exhibits an overprojected tip and divergent footplates, the lateral portion of the footplates will be resected partially, then approximated. If the tip is underprojected or has normal projection, the divergent footplates will be approximated without resection. Should the subnasale and the base of the columella be protruding, the soft tissue between the footplates will be removed to avoid excess fullness in this site as a result of the approximation of the footplate. However, when the footplates are divergent, the columella base and nasal spine area are often retracted, setting an auspicious stage for approximation of the footplates without having to excise the soft tissue. This maneuver not only narrows the columella base, it also advances it caudally. Longstanding caudal deviation of the septum may also create asymmetry of the footplates, which will not respond to mere repositioning of the septum, and often requires repositioning of the footplates with mobilization and fixation to the contralateral footplates.
这项前瞻性与回顾性相结合的研究旨在回顾内侧脚的鼻小柱基底异常情况、其手术矫正方法以及鼻小柱基底改变所导致的动态变化。前瞻性研究中，在连续20例初次鼻整形手术过程中对40个鼻小柱基底进行了测量。测量了鼻小柱基底在其最后尾侧位置之间的距离，以及鼻小柱基底的厚度、长度和宽度。还观察了鼻孔的形状并将其与鼻小柱基底的形态相关联。鼻小柱基底之间的距离为7.5至15毫米，平均为11.4毫米。鼻小柱基底的长度为4至7.5毫米，平均为5.81毫米。鼻小柱基底的厚度平均为1.06毫米，范围为0.80至1.5毫米。鼻小柱基底的宽度为2.5至7.0毫米，平均为4.48毫米。在对连续295例鼻整形手术的回顾性研究中，76例（25.8%）患者的鼻小柱基底发生了改变。在这些病例中，29例手术（9.8%）是为了缩窄鼻小柱基部并推进鼻下点：在24例患者（8.1%）中，该操作的目的仅是缩窄鼻小柱基部；在5例患者（1.7%）中，进行该手术是为了增加鼻尖突出度、为鼻尖提供更好的基础、将鼻下点向尾侧推进并缩窄鼻翼基部。16例患者（5.4%）的鼻小柱不对称得到了矫正，2例患者（0.7%）主要切除鼻小柱基底以降低鼻尖突出度。对鼻基底的详细分析将决定以下与鼻小柱基底改变相关的操作之一。如果患者表现为鼻尖过度突出且鼻小柱基底分开，则将部分切除鼻小柱基底的外侧部分，然后使其靠近。如果鼻尖突出不足或正常突出，则将分开的鼻小柱基底靠近而不进行切除。如果鼻下点和鼻小柱基部突出，则将切除鼻小柱基底之间的软组织，以避免由于鼻小柱基底靠近而导致该部位过度丰满。然而，当鼻小柱基底分开时，鼻小柱基部和鼻棘区域通常会回缩，为鼻小柱基底靠近创造了有利条件，而无需切除软组织。该操作不仅缩窄了鼻小柱基部，还将其向尾侧推进。长期的鼻中隔尾侧偏斜也可能导致鼻小柱基底不对称，这仅通过鼻中隔重新定位无法解决，通常需要对鼻小柱基底进行重新定位，并将其活动并固定到对侧鼻小柱基底上。
