The lost muscles of the nose

This is a review of the muscular anatomy of the nose. Areas of inconsistency in the main anatomy texts are highlighted and concentrate particularly on the omission of three identifiable muscles from modern textbooks. Two topographical areas of the nose in need of further anatomical development are identified. In a sample of 121 subjects from the general population, 40% were found to be incapable of flaring the nostrils voluntarily or subconsciously in conjunction with energetic inspiration with the mouth closed. The authors recommend systematic clinical assessment of the nasal musculature be incorporated in the pre- and postoperative examination of the rhinoplasty patient. The division of the nose into five sections for assessment is proposed and the muscles contributing to each area are defined together with their individual surgical relevance.This paper was presented at the Frank Cort Prize Meeting, Birmingham, United Kingdom, 12 March 1994     

鼻尖的类型和手术设计

目的探讨适合国人的鼻尖分类体系,并设计相应的手术方案。方法根据鼻的形态差异,将鼻尖分为5型,即前伸型、后缩型、低垂型、肥大型和混合型,综合应用切除、缝合和填充移植物的手术方法行鼻尖修整术,并对手术效果进行评价。结果本组1028例患者,术后鼻孔不对称10例,7例经再次手术后满意;线结反应3例;移植物从切口突出1例。随访973例患者3周至7年,效果满意。结论鼻尖分类体系能够指导手术设计和操作,并获得稳定、满意的手术效果。     

鼻尖的类型和手术设计

目的探讨适合国人的鼻尖分类体系,并设计相应的手术方案。方法根据鼻的形态差异,将鼻尖分为5型,即前伸型、后缩型、低垂型、肥大型和混合型,综合应用切除、缝合和填充移植物的手术方法行鼻尖修整术,并对手术效果进行评价。结果本组1028例患者,术后鼻孔不对称10例,7例经再次手术后满意;线结反应3例;移植物从切口突出1例。随访973例患者3周至7年,效果满意。结论鼻尖分类体系能够指导手术设计和操作,并获得稳定、满意的手术效果。     

鼻头端肥大的分型及其治疗策略

目的 根据患者鼻头端的不同解剖特点,将鼻头端肥大分为软组织肥厚型、鼻翼软骨肥厚型、分离型鼻翼软骨、整形不当致鼻头肥大型、复合型鼻头肥大5个类型,提出各型鼻头端肥大的针对性治疗策略.方法 2010年1月至2012年3月,临床治疗92例鼻头端肥大患者,年龄21～46岁,平均29岁.根据不同分型采用不同手术方式,包括注射确炎舒松和手术减薄、鼻翼软骨分区塑形、耳软骨、鼻中隔软骨移植鼻尖成形和(或)鼻延长、鼻孔成形、鼻小柱延长等.结果 术后随访3个月至1年,患者鼻头均明显缩小,鼻翼沟重塑后轮廓分明,鼻部各亚单位比例协调,鼻背弧度自然.复诊结合术前、术后照片比较进行满意度评价:92例中优59例,良26例,一般7例.结论 根据鼻头端肥大的不同病因,先确定所属解剖类型,再采取相应的治疗策略,才能取得最好的整形美容效果.     

亚单位原则在鼻尖成形术中的应用

目的 介绍以亚单位原则指导鼻尖成形术的方法和经验。方法 将鼻尖分成鼻翼、软组织三角、尖部和鼻小柱等亚单位，根据各亚单位的形态结构特点，结合鼻尖的美学参数，判断受术者鼻尖外观的缺陷，据以设计3种手术方法：切除法、缝合法和移植法。结果 随访216例，手术满意率89％（192例），基本满意率9％（20例），不满意率2％（4例）。结论 亚单位原则指导鼻尖成形术，能获得准确、稳定和满意的手术效果。     

Rhinoplasty. The Difficult Nasal Tip: Total Resection of the Alar Cartilages

There are many ways to reconstruct and make nasal tips more attractive. Sometimes we cannot find the best way unless we at least remove all surplus from the tip. This may occur in primary or secondary rhinoplasty. In principle, anything is possible when relocating and reconstructing. However, sometimes we face reality when we uncover the tip: broken or bulging cartilages that are difficult to put right. For this reason, in 1987 we thought of totally resectioning the alar cartilages in a case of secondary rhinoplasty with an unsightly appearance. After a year the result was seen to be correct from an aesthetic and a functional perspective and is still so today. Aesthetically, it kept its shape and did not collapse with nasal respiratory failure. We covered the end of the crus medialis with a small, temporary, one- to two-layered fascia patch. Except in exceptional cases, we now use this procedure: Total sectioning of the alar cartilages including the domes, or maintenance of them by preserving the fibroadipose tip tissue with a suture in the middle of the end of the crus medialis and by covering this with temporary fascia, which usually has two layers depending on the thickness of the skin of the tip. This procedure is indicated mainly in secondary rhinoplasty when the cartilages of the tip are completely destroyed, and in primary rhinoplasty when the tip is excessively wide and bulbous. Our philosophy is, therefore, elegance and beauty of the nasal tip with a solid and equilateral base without prejudices.     

Nasal tip repair with axial flap of nasal muscle

The procedure described here consists of a myocutaneous axial flap with lateral pedicle. It uses the transverse part of the nasal muscle that goes forward in rotation and the lateral and superior portions of the flap in the V-Y. The procedure is useful for repairing losses of nasal tip and the surrounding area. It is a simple method that can be used to reconstruct the brim near the tip of the nose, yielding an aesthetically and functionally efficient nose.     

Aesthetic Rhinoplasty of the Asian Nasal Tip: A Brief Review

Tip surgery, the most important part of the rhinoplasty procedure, has entered a new era in the past few decades. Various treatment protocols have been attempted. To date, however, opinions on the management of the Asian tip have not been solidified. To generalize and provide appropriate guidelines for the treatment of typical Asian tips, an English literature search from 1977 to March 2007 was conducted. Finally, a total of 26 papers were selected for review. The full text of each paper was read carefully, and data were extracted. Then all extracted information was imported into Microsoft Excel. Nine articles treating 11 groups of patients described the suitable techniques for Asian nasal tips, with 81.8% of the groups advocating that the protocol include a grafting technique, 64% reporting use of the grafting technique alone, and 9% applying cartilage reduction and a suturing technique. Of the 11 (18%) groups, 2 attempted more than one technique. Because of the Asian nasal tip's innate qualities, success with nasal tip plasty for Asians depends on the combined application of appropriate suturing, grafting, and defatting, with grafting techniques contributing the most.     

鼻整形术中应用自体耳软骨治疗鼻尖低平的效果和安全性

目的 探究鼻整形术中应用自体耳软骨治疗鼻尖低平的效果和安全性。方法 选取于河南大学附属 南阳南石医院2021年1月-2023年1月接受鼻整形手术治疗的100例患者为研究对象,以随机数字表法分为对 照组和观察组,每组50例。对照组应用膨体假体填充实施鼻整形手术治疗,观察组应用自体耳软骨实施鼻 整形手术治疗,比较两组临床疗效、鼻部形态改善情况及并发症发生率。结果 观察组临床治疗总有效率 为94.00%,高于对照组的80.00%,差异有统计学意义（ P ＜0.05）;观察组术后鼻长、鼻尖高度、鼻尖角、 鼻尖宽水平均优于对照组,差异有统计学意义（ P ＜0.05）;观察组并发症发生率为4.00%,低于对照组 的22.00%,差异有统计学意义（ P ＜0.05）。结论 鼻整形术中应用自体耳软骨治疗鼻尖低平可有效改善鼻 长、鼻尖情况,提高治疗效果,且并发症较少。     

Transfixion incision as an initial technique in nasal tip deprojection

BACKGROUND:

The overprojected nasal tip presents a significant challenge to the surgeon performing rhinoplasty. Full transfixion incision as a means of dealing with this deformity has been studied only in combination with other surgical methods.

OBJECTIVES:

To determine whether transfixion incision alone would result in significant nasal tip deprojection, and if skin thickness had an effect on the extent of deprojection the procedure yielded.

METHOD:

Seventy-two consecutive patients with an aesthetic goal of nasal tip deprojection were enrolled. The sole surgical means of deprojection used was transfixion incision. Subjects were categorized as thin-, medium- or thick-skinned based on the surgeon’s analysis. These groups were compared in terms of their postprocedural nasal tip deprojection.

RESULTS:

Using transfixion incision as the sole means of correcting this deformity resulted in a mean nasal tip deprojection of 1.6 mm (ranging from 0 mm to 3 mm). Patients in the thin skin group had a mean deprojection of 2.12 mm. This was significantly greater than for both the medium- and thick-skinned groups. There was no significant difference between the medium- and thick-skinned groups.

CONCLUSIONS:

Surgeons may use skin thickness when planning interventions for correcting nasal tip overprojection. When used alone, transfixion incision resulted in tip deprojection comparable with that achieved when combined with other methods, particularly for thin-skinned patients. Surgeons can thus use a graduated approach in which transfixion incision, the least destructive method, is used before proceeding with other interventions.     

鼻尖突出不足合并鼻指数过大的鼻型特点及联合治疗

目的 应用人体测量学以比例关系描述特定鼻型,探讨鼻尖突出不足合并鼻指数过大的鼻型特点及治疗方法,为鼻整形定量研究提供思路.方法 2010年3月至2011年10月,测量27例鼻尖低平、鼻翼肥大的青年女性鼻形态并计算指数值.患者均行隆鼻、鼻尖抬高并前延、鼻翼缩小三项鼻整形术.结果 随访3～12个月,效果满意.术后鼻指数、鼻宽深指数、鼻尖突出度均在正常范围内,其中部分患者比例值达到美学范围.结论 外鼻形态测量比例值能较客观、准确地描述某种鼻型.我国汉族青年女性,鼻指数大于82.05％,鼻尖突出度小于37.50％,可归类为鼻尖突出不足合并鼻指数过大鼻型,此类鼻型应用三项手术综合治疗,协调各亚单位比例,可塑造和谐美观的鼻型.     

自体鼻中隔软骨短鼻延长及鼻尖成形术

目的利用自体鼻中隔软骨,对短鼻畸形的患者行鼻部延长及鼻尖成形术,手术易行,在西方国家得到广泛的应用,但西方人与东方人的解剖结构及审美观有所差异,如何使这一手术方法更适合东方人,这是一些整形外科医生探索的目的之一。方法从1998年以来,韩国大邱S-整形医院、LOGOS整形医院、天主教大学医疗病院整形与重建外科的326例短鼻或鼻尖低矮的病人,女298例,男28例。使用鼻孔侧切口入路、鼻小柱切口入路采集鼻中隔软骨,利用中隔软骨延长鼻部长度并利用部分雕刻成形的软骨延长鼻尖部、采用或不采用硅胶假体对鼻梁部充填。结果效果良好,平均鼻部延长5mm,手术时间平均约为1小时50分钟。平均随访3年,未见明显吸收及变形、感染、排异现象。结论利用自体鼻中隔软骨,对短鼻畸形的患者行鼻部延长及鼻尖成形术是个安全有效的方法。     

局部或邻位皮瓣在鼻尖缺损修复中的功能和美学评价

目的 介绍应用局部或邻位皮瓣修复鼻尖部缺损创面的方法和经验.方法 在遵循鼻亚单位组成的美学原则基础上,根据鼻尖部创面的大小、形状及供区组织可利用情况,分别选择相应的局部或邻位皮瓣(如额鼻皮瓣、双叶皮瓣、改良菱形皮瓣、鼻唇沟皮瓣及额正中皮瓣等)修复创面,供区直接缝合.结果 手术治疗共83例,创面面积最小约0.6 cm×0.6 cm,最大约2.5 cm×2.5 cm.术后皮瓣全部成活,无明显并发症发生.其中76例随访1～36个月,鼻外形轮廓较好,修复组织与周围皮肤相匹配,肿瘤患者未见复发.结论 遵循鼻亚单位美学原则,应用局部皮瓣能修复鼻尖部中等以上创面,且色泽、质地、轮廓等方面能达到较好的匹配和协调.     

Implications for Nasal Recontouring: Nasion Position Preferences as Determined by a Survey of White North Americans

White North American men (n = 75) and women (n = 75) were surveyed to investigate gender specific preferences of nasion position, which may aid plastic surgeons in nasal shaping during rhinoplasty. The subjects were asked to rank preferences of various nasion positions from life-size, scaled, sketched male and female profiles. Nasion positions with regard to height (anterior projection) and level (vertical position) were altered, whereas all other facial and nasal anthropometric measurements were held constant. The nasion heights were drawn at 7, 10, and 13 mm anteriorly to the corneal plane, and the nasion levels were drawn at the supratarsal fold (ST), upper lid ciliary margin (CM), midpupil (MP), and lower limbus (LL). The rank selections made by the female and male subjects of both gender profiles demonstrated statistical significance, as demonstrated by one-way analysis of variance (ANOVA) of ranks (p < 0.001). Further analysis using a post-Dunn test was completed to delineate significant gender specific preferences for the aesthetic nasion level and height. Female nasion levels were preferred at CM or MP over LL or ST on the basis of female ranks, and at ST, CM, or MP over LL on the basis of male ranks (p < 0.05 for all comparisons). Additionally, female nasion heights were preferred at 10 mm > 13 mm > 7 mm anterior to the corneal plane on the basis of both female and male ranks (p < 0.05 for all comparisons). Male nasion levels were preferred at ST, CM, or MP over LL on the basis of both male and female ranks (p < 0.05 for all comparisons). Male nasion heights were preferred at 10 mm > 13 mm > 7 mm anterior to the corneal plane by both male and female ranks (p < 0.05 for all comparisons). In summary, both the male and female subjects strongly disliked a low nasion height of 7 mm and a low nasion level placed at LL for both gender profiles. Both the male and female subjects were most particular concerning nasion height, preferring a 10-mm projection and strongly disliking a deeper 7-mm height for both male and female profiles. Both the male and female subjects were more tolerant of nasion level alterations. Whereas the male subjects tolerated nasion levels at ST, CM, or MP for either gender profile, the female subjects preferred only nasion levels at CM and MP for the female gender. Overall, these findings may lend support to recent trends in radix augmentation during rhinoplasty, especially among male patients.Accepted to the ASPS-PSEF-ASMS 2002 Annual Meeting