四川雅安地区汉族中青年的外鼻鼻下部活体测量研究

目的　了解汉族中青年外鼻鼻下部的解剖形态,为下鼻部整形手术提供有关参考。方法　对汉族２００ 名１９ ～３０ 岁中青年外鼻鼻下部进行测量,男、女各１００ 名,测量项目：鼻翼宽、鼻深、鼻小柱宽和高、鼻尖宽和高、鼻基底鼻尖角、鼻孔宽和高、鼻翼鼻小柱角、鼻孔上部最小角、鼻翼厚度和突出距共１３ 个数据,观察鼻孔、鼻翼附着外侧缘形态,比较测量值的正常范围、变异系数、分布频数,并作统计分析。结果　发现鼻翼宽、鼻深、鼻小柱宽、鼻尖宽和高、鼻孔宽和高、鼻孔上部最小角、鼻翼突出距的测量值男女之间差异有显著意义Ｐ＜ ０ ．０１ ,鼻翼厚度差异较有显著意义,Ｐ＜ ０ ．０５ ,对临床有意义。男性鼻下部宽、鼻深等４ 组测量值分布集中,女性鼻深、鼻小柱宽等８ 组测量值分布集中。鼻孔外形可描述为扇形和扇形一边为底的三角形相连而成。结论　所得参数,对临床工作有指导意义     

Secondary Rhinoplasty of the Asian Nose: Correction of the Contracted Nose

The contracted nose is a unique entity that follows primary rhinoplasty in the Asian patient. The proposed reasons for this complication are capsular contraction from a silicone nasal implant, pressure necrosis of the lower lateral cartilage resulting from the nasal implant, and infection after alloplastic implantation. The two principal anatomic constituents that must be addressed at the time of secondary rhinoplasty are the lower lateral cartilages and the skin envelope. The lower lateral cartilages should be derotated, projected, and transfixed with an extended spreader graft. Additional onlay grafting may be required to provide greater nasal tip derotation and projection. A transcolumellar incision situated at the columellar-labial angle permits undermining of the upper lip skin to release tension on the incision. If the nasal tip retraction is severe, then the skin envelope may be insufficient to provide coverage to the new cartilaginous framework. In this case, a paramedian forehead flap is recommended to provide adequate tissue coverage. Correction of alar–columellar disparity should be undertaken with composite grafting only after 6 months have transpired to gauge the ultimate relation between the alae and columella. Infection that arises after correction of the contracted nose can be devastating. It should be treated aggressively, but tailored to the severity of the infection. Wound tension along the columella may predispose to skin necrosis and consequent cartilage exposure, which should be managed in turn with prostaglandin emollients to accelerate wound healing and to prevent infection.     

鼻表浅肌肉腱膜系统的解剖研究与临床应用

目的　探讨鼻表浅肌肉腱膜系统的存在及其临床意义。方法　对 3 0具成人尸体行大体解剖观察。结果　表浅脂肪层、肌肉腱膜层由肌肉层和包绕肌肉层表面的深浅两层腱膜组织构成。这样 ,鼻部肌肉和其表面的腱膜从解剖角度上可视为一个特定的结构单位 ,在此称之为鼻部表浅肌肉腱膜系统(NasalSMAS)。且发现鼻部表浅肌肉腱膜系统与面部表浅肌肉腱膜系统的相应结构层次移行。所以 ,又可认为鼻部表浅肌肉腱膜系统是面部表浅肌肉腱膜系统之一部分。其中的鼻部诸肌相互协调 ,共处在一个均衡的结构体系之中。表浅肌肉腱膜系统下方组织疏松 ,无重要血管神经走行是理想的剥离平面。结论　鼻表浅肌肉腱膜系统的完整对外鼻的形态维持具有重要意义 ,鼻部整形手术理想的剥离平面应位于鼻表浅肌肉腱膜系统的深面。     

Rhinoplasty in the older patient

Rhinoplasty is often indicated in the older patient, either as an isolated procedure or in continuous or staged combination with other facial rejuvenative operations. The operations must be tempered with conservatism and artistic judgment. The nose of an older person should look natural and inconspicuous and fit the patient's face. Because of possible coronary or hypertensive problems, epinephrine in the local anesthetic solution should be used in lesser concentrations, requiring a longer wait for its full vasoconstrictive effect. Nasal cartilage is tougher, and the nasal bone more brittle in the older patient. In addition to the usual complete rhinoplasty, the partial rhinoplasty is a useful operation for the older individual.     

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.     

内镜辅助歪鼻矫正术

目的探讨内镜在面部轮廓改形中的临床应用价值。方法在内镜辅助下对12例歪鼻求术者鼻骨支架进行截骨改形,松解外在及内在牵拉力量,复位鼻骨、矫直鼻中隔,重塑鼻支架。结果内镜可清楚显示手术区歪曲结构,视野清晰,截骨更加精确和容易。所有求术者创伤小,无医源性意外创伤。术后随访1～12个月,鼻轮廓改善满意。结论内窥镜辅助歪鼻矫正术有助于获得良好的手术效果。     

歪鼻畸形的整形及通气功能恢复

目的 探讨治疗伴或不伴鼻中隔偏曲的歪鼻畸形的手术方法,观察外观效果和功能恢复情况.方法 对59例陈旧外伤性和先天性歪鼻畸形患者,经鼻和鼻中隔整形手术矫正,术前经鼻声反射测量法检查,术后进行复查及随访.结果 所有病例伤口均一期愈合,治疗效果满意,经3个月～2年随访,无复发和并发症.结论 鼻和鼻中隔整形术均为治疗歪鼻畸形的有效术式,鼻声反射测量法适用于手术前后通气功能的对比评估.     

Rhinometry: An Important Clinical Index for Evaluation of the Nose Before and After Rhinoplasty

Background Preoperative planning and postoperative outcome assessment in rhinoplasty are important. For preoperative planning, some standard relationships are defined and evaluated primarily with standard photographs, but photographs do not necessarily reflect reality. Outcome assessment, on the other hand, is mostly subjective, and again, even photographic analyses may not address real changes after rhinoplasty. Methods “Rhinometry” is introduced as a clinical method for preoperative evaluations and postoperative judgments, and rhinometric parameters are defined. Measurements of these parameters were performed for 300 patients before rhinoplasty and in the follow-up visits 3 months postoperatively. Results Preoperatively, the nasal length and tip projection for most patients were more than ideal. There was moderate reduction in nasal length (mean, 9.21 mm) and a decrease in tip projection (mean, 3.34 mm) for the majority of the patients after rhinoplasty. Reductions in nasal length, tip projection, bony base width, alar base width, and alar base width during a smile were statistically significant. Patients who underwent surgery using the closed approach had significantly more reduction in nasal length and less reduction in tip projection. All the patients were satisfied with these pre- and postoperative data. Rhinometry changed the ideas of the authors about some changes that their operative approaches produce. Conclusions Rhinometry can change the ideas of plastic surgeons about the changes their operative approaches accomplish and can be a very useful guide for patients. It is recommended as a part of the pre- and postoperative physical examination of patients undergoing rhinoplasty.     

External Rhinoplasty for the Arabian Nose: A Columellar Scar Analysis

This study aimed to evaluate columellar scar problems after external rhinoplasty in the Arabian population, and to analyze the technical factors that help prevent such problems and maximize the scar cosmesis. The investigation was conducted in university and private practice settings of the author in Alexandria, Egypt. A total of 600 Arab patients who underwent external rhinoplasty were included in the study. All the patients underwent surgery using the external rhinoplasty approach, in which bilateral alar marginal incisions were connected by an inverted V-shaped transcolumellar incision. At completion of the procedure, a two-layer closure of the columellar incision was performed.At a minimum of 1 year postoperatively, the columellar scar was evaluated subjectively by means of a patient questionnaire, and objectively by clinical examination and comparison of the close-up pre- and postoperative basal view photographs. Objectively, anything less than a barely visible, leveled, thin, linear scar was considered unsatisfactory. Subjectively, 95.5% of the patients rated the scar as unnoticeable, 3% as noticeable but acceptable, and 1.5% as unacceptable. Objectively, the scar was unsatisfactory in 7% of the cases. This was because of scar widening with or without depression (5%), hyperpigmentation (1.5%), and columellar rim notching (0.5%). The use of a deep 6/0 polydioxanon (PDS) suture significantly decreased the incidence of scar widening (p < 0.005).The columellar incision can be used safely in the Arab population regardless of their thick, dark, and oily skin. Technical factors that contributed to the favorable outcome of the columellar scar included proper planning of location and design of the incision used, precise execution, meticulous multilayered closure, and good postoperative care.     

鼻表浅肌肉腱膜系统在鼻成形术中的应用

目的　以鼻表浅肌肉腱膜系统为理论依据 ,进行鼻成形手术。方法　对本组 5 3 6例鼻成形手术患者假体置放层次进行回顾、比较和分析 ,并进而改为将假体放置在鼻表浅肌肉腱膜系统深面。结果　鼻模型假体放置在鼻表浅肌肉腱膜系统深面 ,成型更加自然、逼真 ,假体稳固 ,减少了并发症。结论　鼻成形手术理想的剥离平面应位于鼻表浅肌肉腱膜系统的深面 ,鼻SMAS对外鼻的形态学维持具有重要意义。     

鼻内镜下鼻-鼻中隔整形术治疗外伤性歪鼻畸形

目的总结鼻内镜下治疗外伤性歪鼻畸形的经验。方法选择外伤性歪鼻畸形患者42例,其中“C”型偏曲15例,“O”型(偏斜型)偏曲17例,“S”型偏曲10例,分别在术前、术后测量其偏离值(“S”型两个偏曲,暂未进行统计),在鼻内镜下行鼻-鼻中隔整形术,术后进行随访。结果32例“C”型偏曲、“O”型偏曲术前测量偏离值为(5.68±2.03)mm,术后测量偏离值为(2.17±1.09)mm,经配对t检验,手术前后歪鼻的偏离值差异有显著性意义(t=6.877,P<0.001),临床治愈率占62.5%、有效率占87.5%。结论鼻内镜下鼻-鼻中隔整形术是治疗外伤性歪鼻畸形有效的术式,能同时解决鼻腔美学和鼻腔功能的问题,并具有精确、微创、复发率低等优点。     

A Systematic Approach to Rhinoplasty of the Japanese Nose: A Thirty-Year Experience

The Japanese nose exhibits a combination of leptorrhine and mesorrhine features that mandates an innovative treatment strategy. Unlike elsewhere in Asia, the Japanese nose often has adequate dorsal height, and at times even dorsal convexity, but maintains a more retruded and amorphous tip configuration. The proposed systematic approach to Japanese rhinoplasty is divided into four categories: (1) dorsal augmentation with or without tip augmentation, (2) dorsal reduction with tip augmentation, (3) tip augmentation only, and (4) dorsal reduction only. The use of autologous and alloplastic materials to achieve the desired aesthetic objectives is described herein. A layered auricular graft technique is outlined for tip surgery, and a unique nasal implant design is discussed.