Byrd H S, Salomon J, Flood J
Department of Plastic Surgery at the University of Texas Southwestern Medical Center, Dallas, USA.
Plast Reconstr Surg. 1998 Nov;102(6):2148-57. doi: 10.1097/00006534-199811000-00055.
Correcting the crooked nose remains one of the most challenging problems in rhinoplasty. When faced with a twisted nose, rhinoplasty surgeons tend to be divided into those who perform an anatomic reconstruction and those who prefer camouflage techniques. Regardless of the approach used, the revision rate remains fairly high. An anatomic correction of the twisted nose through an open approach was performed. The septum was freed from the extrinsic forces of the deformed nasal bones and upper and lower lateral cartilages. The residual true septal injury was then evaluated. The septal deformity was addressed through quadrangular cartilage resection, repositioning of the caudal septum in the anatomic midline, and correction of the dorsal septal deformity with horizontal control sutures. The skeletal support was then reconstructed with the use of a spreader-extension graft on the concave side and a batten graft on the opposite side. The nasal tip was set relative to the dorsum by fixation to the extension grafts. Residual lateral crus deformities were corrected by a combination of lateral crural spanning sutures or alar spreader grafts. With this approach, straightening the crooked nose without compromising skeletal support or nasal aesthetics was successful.
矫正歪鼻仍然是鼻整形术中最具挑战性的问题之一。面对扭曲的鼻子时，鼻整形外科医生往往分为两类，一类进行解剖重建，另一类则倾向于采用掩饰技术。无论采用何种方法，修复率仍然相当高。通过开放式入路对扭曲的鼻子进行了解剖矫正。鼻中隔从变形鼻骨以及上、下外侧软骨的外在力量中游离出来。然后评估鼻中隔的残余真性损伤。通过四边形软骨切除术、将鼻中隔尾端重新定位到解剖学中线以及使用水平控制缝线矫正鼻中隔背侧畸形来解决鼻中隔畸形问题。然后在凹侧使用撑开-延长移植物，在相对侧使用板条移植物重建骨骼支撑。通过固定到延长移植物将鼻尖相对于鼻背进行定位。通过外侧脚跨越缝线或鼻翼撑开移植物的联合使用矫正残余的外侧脚畸形。采用这种方法，成功地矫正了歪鼻，同时又不损害骨骼支撑或鼻部美观。
