Deva A K, Merten S, Chang L
Department of Plastic and Maxillofacial Surgery at Liverpool Hospital, Sydney, Australia.
Plast Reconstr Surg. 1998 Sep;102(4):1230-7. doi: 10.1097/00006534-199809040-00052.
A number of materials, both biologic and alloplastic, have been used for nasal augmentation. Although biologic bone and cartilage grafts are associated with lower infection rates, they are also associated with long-term resorption and donor-site morbidity. Alloplastic materials, in particular silicone, have been associated in the literature with extrusion and infection but have the advantages of being affordable and easy to reshape with no requirement for harvesting autografts. A 10-year experience with silicone nasal augmentation documenting clinical experience, acute and long-term complications, and patient satisfaction was reviewed. All patients undergoing silicone augmentation rhinoplasty between July of 1985 and December of 1995 were reviewed. Preoperative nasal phenotype, operative data, and postoperative outcome were recorded. Long-term follow-up was undertaken using a telephone survey. There were 422 patients who underwent silicone nasal augmentation from July of 1985 to December of 1995. Only nine were men. The indications were for aesthetic nasal augmentation in 98 percent, and the majority (98 percent) were of South East Asian origin. Mean age was 26 (range 17 to 36), and 41 of the 422 patients had had previous nasal augmentation performed before presentation. Twenty-three patients (5.5 percent) had complications requiring removal of the implant within 30 days of surgery. These included displacement, prominence, hemorrhage, and excessive pressure in addition to obvious supratip deformity. On late follow-up, a further 18 patients (4.3 percent) had subsequent removal of the prosthesis. The most common reason for this was either displacement or over-prominence, more often judged by the surgeon than the patient. There were only two patients (0.5 percent) who had extrusion of the prosthesis. A total of 266 patients (63 percent) were contacted for a telephone interview. The majority of patients (84.2 percent) were satisfied with their nasal shape. Of the 42 patients (15.8 percent) who were not satisfied, 21 patients still wanted further augmentation of their nose. Photographic analysis of 198 patients showed a mean augmentation of 16.5 percent (range 4.0 to 27.5). Amount of augmentation correlated with preoperative nasal phenotype. Silicone nasal augmentation is a safe and effective procedure when used for moderate increases in nasal height. Contrary to previous reports, this series showed no associated infection. If the implant is shaped appropriately to the patient's nasal phenotype, the risk of extrusion may be reduced.
多种材料，包括生物材料和异体材料，都已用于鼻整形术。尽管生物骨和软骨移植的感染率较低，但它们也与长期吸收和供区并发症有关。异体材料，特别是硅胶，在文献中与挤出和感染有关，但具有价格低廉、易于塑形且无需采集自体移植物的优点。回顾了10年硅胶鼻整形术的临床经验、急性和长期并发症以及患者满意度。对1985年7月至1995年12月期间接受硅胶鼻整形术的所有患者进行了回顾。记录术前鼻外形、手术数据和术后结果。通过电话调查进行长期随访。1985年7月至1995年12月期间有422例患者接受了硅胶鼻整形术。只有9例为男性。98%的适应症是美容性鼻整形，大多数（98%）患者来自东南亚。平均年龄为26岁（范围17至36岁），422例患者中有41例在就诊前曾接受过鼻整形术。23例患者（5.5%）在术后30天内出现需要取出植入物的并发症。这些包括移位、突出、出血、压力过大以及明显的鼻尖上区畸形。在后期随访中，又有18例患者（4.3%）随后取出了假体。最常见的原因是移位或过度突出，更多是由外科医生而非患者判断。只有2例患者（0.5%）出现假体挤出。总共联系了266例患者进行电话访谈。大多数患者（84.2%）对其鼻外形满意。在42例（15.8%）不满意的患者中，21例仍希望进一步隆鼻。对198例患者的照片分析显示平均增高16.5%（范围4.0至27.5）。增高量与术前鼻外形相关。当用于适度增加鼻高度时，硅胶鼻整形术是一种安全有效的手术。与先前的报道相反，本系列未显示相关感染。如果植入物根据患者的鼻外形进行适当塑形，挤出风险可能会降低。
