Becker D G, Toriumi D M, Gross C W, Tardy M E
Dept of Otolaryngology-Head & Neck Surgery, University of Pennsylvania, Philadelphia 19104, USA.
Facial Plast Surg. 1997 Oct;13(4):291-7. doi: 10.1055/s-0028-1082428.
We describe the use of powered instrumentation for precise modification of the bony nasal dorsum. Specific modifications were made to design a drill specifically for the bony nasal dorsum. This drill has a protective sheath that covers all but the active part of the drill, protecting the skin-soft tissue envelope, and it also has suction at the resection site. In some cases an osteotome is used to reduce the hump and the drill is used to achieve additional reduction and to smooth the exposed edges under direct vision. In other cases the entire bony hump is reduced using the drill. The nasal dorsum drill offers a precise alternative to the rasp. The precision of the drill is highlighted in cases in which limited reduction is needed, as in cases of a single or several spicules requiring reduction and smoothing after osteotomy, or a single 4 mm raised area requiring limited reduction. The design of rasps makes it difficult to work on these focal areas without unnecessarily rasping surrounding areas, whereas the drill may be used to reduce the entire hump, to smooth the edges after osteotomy, or in a more precise and limited fashion when indicated. The drill may be less traumatic to the skin-soft tissue envelope because it does not rely on the potentially bruising back and forth motion typical of rasping. The nasal dorsum drill may decrease the incidence of bony dorsal irregularities after rhinoplasty.
我们描述了使用动力器械对鼻骨背进行精确修整的方法。对器械进行了特殊改良以设计出专门用于鼻骨背的钻头。这种钻头有一个保护鞘，可覆盖钻头除工作部分之外的所有部位，从而保护皮肤软组织包膜，并且在切除部位还有吸力装置。在某些情况下，会使用骨凿来降低鼻背驼峰，然后使用钻头在直视下进一步降低驼峰并使暴露的边缘光滑。在其他情况下，则使用钻头来整体降低鼻骨驼峰。鼻骨背钻头为锉刀提供了一种精确的替代方案。在需要有限度降低高度的情况下，例如在截骨术后需要降低和打磨单个或多个骨碎片，或者单个4毫米隆起区域需要有限度降低高度时，钻头的精确性就凸显出来了。锉刀的设计使其难以在这些局部区域操作而不致于不必要地锉磨周围区域，而钻头可用于整体降低驼峰高度、在截骨术后使边缘光滑，或者在有需要时以更精确和有限的方式使用。钻头对皮肤软组织包膜的创伤可能较小，因为它不依赖于锉刀那种典型的可能造成瘀伤的前后运动。鼻骨背钻头可能会降低隆鼻术后鼻骨背不规则的发生率。
