Naficy S, Baker S R
Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, USA.
Arch Otolaryngol Head Neck Surg. 1998 Jul;124(7):809-13. doi: 10.1001/archotol.124.7.809.
Correction of the aesthetically short nose is one of the most challenging problems in facial plastic surgery. We discuss several techniques aimed at the correction of this problem and propose an algorithm based on the desired effect of the lengthening procedure on tip rotation. Five principal techniques for nasal lengthening are discussed, with figures and cases to illustrate the concepts: (1) the flying buttress graft, which is made up of a single or paired spreader grafts secured to a columellar strut; (2) caudal septal grafts and (3) tip grafts of various shapes; (4) radix grafts placed to elevate the nasion; and (5) interposition grafts placed between the upper and lower lateral cartilages. When the tip is overrotated, small to moderate gains in nasal length may be achieved by a triangular-shaped caudal septal graft or a shield graft that is backed by wedge grafts near the tip. More substantial lengthening and derotation can be achieved by the flying buttress technique or by interposition cartilage or composite grafting between the upper and lower lateral cartilages. With a nasal tip that is adequately rotated or underrotated, nasal lengthening can be achieved by a rectangular-shaped caudal septal graft or by a full-length shield graft. An onlay graft to augment the radix and elevate the nasion to a higher point on the dorsum can be used alone or in combination with a tip or septal graft.
矫正美学上的短鼻是面部整形手术中最具挑战性的问题之一。我们讨论了几种旨在解决这一问题的技术，并基于鼻尖旋转延长手术的预期效果提出了一种算法。文中讨论了五种主要的鼻延长技术，并配有图片和病例以阐释相关概念：（1）飞翼式移植，由固定于鼻小柱支柱的单个或成对的鼻背延长移植物组成；（2）鼻中隔尾侧移植物；（3）各种形状的鼻尖移植物；（4）用于抬高鼻根点的鼻根移植物；（5）置于上外侧软骨和下外侧软骨之间的插入式移植物。当鼻尖过度旋转时，通过三角形鼻中隔尾侧移植物或在鼻尖附近有楔形移植物支撑的盾形移植物，可实现鼻长度小到中等程度的增加。通过飞翼式技术或在上外侧软骨和下外侧软骨之间进行插入软骨或复合移植，可实现更显著的延长和去旋转。对于鼻尖旋转适度或旋转不足的情况，通过矩形鼻中隔尾侧移植物或全长盾形移植物可实现鼻延长。用于增大鼻根并将鼻根点抬高至鼻背更高位置的覆盖式移植物可单独使用，或与鼻尖或鼻中隔移植物联合使用。
