Quality of life outcome in revision rhinoplasty in regards to number of revision surgeries and cartilage donor site

ObjectivesRhinoplasty with or without combined septoplasty is one of the most frequently performed procedures in facial plastic surgery. Patient satisfaction and improvement in quality of life (QoL) is the primary goal. This prospective study was conducted to analyse Qol outcome in revision rhinoplasty in regards to number of revision surgeries and cartilage donor site using patient-reported outcome measures (PROMs).MethodsPreoperative and at least 12-months postoperative scores on the Nasal Obstruction Symptome Evaluation (NOSE) questionnaire (range 0-100, lower scores indicate better outcome) and the Rhinoplasty Outcomes Evaluation (ROE) questionnaire (range 0-100, higher scores indicates better outcome) were obtained. Additionally, data on age, gender and number of previous rhinoplasties were assessed. All revision rhinoplasties were performed by one surgeon (author, F.R.) between 2014 and 2017.ResultsSixty-four patients (11 (17.2%) male, 53 (82.8%) female) prospectively enrolled in this study. In 41 (64.1%) cases septal cartilage and in 23 (35.9%) patients ear cartilage was the donor site in revision surgery. Patients with more than one previous surgery (n=18) started with a lower preoperative ROE score (28.2 ± 12.8) compared to patients who had received only one previous surgery. The difference however was not significant (p=0.06). This subgroup still showed significant postoperative improvement (ROE-postop 61.9 ± 24.2; p<0.05).Both cohorts (septal cartilage and ear cartilage) improved significantly in regards to their ROE and NOSE scores after surgery and therefore showed improved health-related QoL. We could not detect any differences in health-related QoL postoperatively in regards to cartilage donor site in revision surgery.ConclusionRevision rhinoplasty improves health-related QoL. There are no differences in ROE- or NOSE-scores postoperatively in regards to graft material (ear- versus septal cartilage). Both subgroups show significantly higher scores postoperatively.     

Normal values for the Rhinoplasty Outcome Evaluation (ROE) questionnaire

Rhinoplasty Outcome Evaluation (ROE) is an easy-to-use questionnaire that allows comprehensive assessment of rhinoplasty-related patient satisfaction. However, normal values for this questionnaire are not known.Objective: To translate and cross-culture adapt the Rhinoplasty Outcome Evaluation questionnaire to Brazilian Portuguese and to establish normality parameters.Materials and Methods: Cross-sectional study with ROE administration to 62 patients waiting for rhinoplasty or septorhinoplasty (Cases) and 100 volunteer subjects without desire or need for nasal surgery (Controls). Assessment of possible sensitivity and specificity cutoffs.Results: The cases' mean score was 6.6 or 27.5% (SD 3.18; min 0; max 15) and controls' mean score was 17.94 or 74.75% (SD 3.91; min 7; max 24). The best cutoff was 12 or 50%, with 95.16% sensitivity and 95% specificity.Conclusion: At the zero-to-24 score of the Brazilian Portuguese ROE, we found 12 as the best cutoff, with 95.16% of sensitivity and 95% of specificity.     

Treatment outcomes of pediatric rhinoplasty: The Asan Medical Center experience

Objective

Performing rhinoplasty in children has been an issue of some debate due to concerns about potential harmful effects on nasoseptal growth. However, there is a paucity of evidence describing the outcomes of pediatric rhinoplasty. This study presents our experience of performing this procedure in children of 17 years of age and younger.

Methods

The study population consisted of 64 Korean children between 4 and 17 years of age who underwent rhinoplasty between May 2003 and August 2011. Forty-six of the patients were boys and 18 were girls with a mean follow-up period of 59 months. The diagnosis of the patients, the extent of the surgical maneuver performed, and the surgical outcomes were reviewed. Subjective satisfaction of the patients was investigated by telephone interview. Surgical outcomes, which were judged by two independent ENT surgeons, were evaluated by comparing preoperative and postoperative photographs. Satisfaction scores were graded using a visual analog scale (from 1 = satisfied, to 4 = dissatisfied). Anthropometric measurements of nasal parameters were performed preoperatively and postoperatively.

Results

Rhinoplasty was performed in our patient cohort due to a deviated nose (32.8%), nasal bone fracture (18.8%), flat nose (6.3%), nasal mass (4.7%), hump nose (3.1%), nasal dermoid sinus cyst (1.6%), and additional cosmetic rhinoplasty for planned septoplasty (32.8%). The median patient satisfaction score was 2.09 compared with a median doctor satisfaction score of 1.81. Anthropometric measurements showed statistically significant improvements in nasal tip projection, nasal length, dorsal height, and radix height after rhinoplasty. Seventeen patients (26.6%) experienced esthetic dissatisfaction such as deviation, tip depression, bulbous tip, short nose, and nostril asymmetry. Eight patients (12.5%) experienced postoperative difficulty in nasal breathing, and two patients (3.1%) complained of transient nasal pain after rhinoplasty. Six patients (9.4%) underwent revision surgery, and four patients (6.3%) were seriously considering a revision operation.

Conclusions

The outcome analysis in our series reveals that rhinoplasty in children is complicated by a high rate of revision and esthetic dissatisfaction. The results of this study may indicate that surgeons should have a conservative attitude and apply strict indication in selecting pediatric rhinoplasty candidates.     

主客观评估在功能性鼻整形术中的应用

目的探讨主客观评估方法在功能性鼻整形术中的应用。方法选择2017年1月至2018年10月在重庆医科大学附属第一医院耳鼻咽喉科接受功能性鼻整形术的患者64例,其中男性32例,女性32例,年龄18~45岁。在术前及术后6个月,分别应用视觉模拟量表(VAS)、鼻阻塞症状评估量表(NOSE)、鼻声反射、鼻阻力检测等评估鼻通气功能,应用VAS、鼻整形结果评估量表(ROE)、外鼻亚单位测量等评估鼻外形情况,应用情感平衡量表及Rosenberg自尊量表评估心理状态,最后行综合满意度分析及各指标间的相关性分析。采用SPSS 23.0软件进行统计学分析。结果与术前相比,术后患者鼻塞VAS、NOSE评分、鼻腔总阻力及鼻腔阻力差异比均显著下降[(1.62±0.85)分比(7.56±1.44)分,(22.62±3.54)分比(69.75±7.85)分,(0.16±0.08)Pa·s/ml比(0.31±0.43)Pa·s/ml,0.33±0.28比0.71±0.32,P值均<0.05];术后患者鼻外形VAS及ROE评分均显著升高[(11.20±3.66)分比(2.70±0.97)分,(17.80±2.71)分比(7.50±1.12)分,P值均<0.05];外鼻亚单位测量示术后鼻背坡长、鼻面角、鼻额角及鼻翼角明显缩小[(29.33±4.26)mm比(33.61±5.24)mm,(135.11±3.81)°比(139.91±6.30)°,(130.63±2.88)°比(136.74±5.72)°,(99.71±4.02)°比(106.27±5.60)°,P值均<0.05];术后情感平衡量表、Rosenberg自尊量表评分明显增高[(5.88±1.54)分比(4.31±1.85)分,(28.31±2.64)分比(22.13±2.77)分,P值均<0.05]。Pearson相关性分析显示,患者满意度与鼻通气主观评分(VAS、NOSE)、鼻外形主观评分(VAS、ROE)、情感平衡量表评分呈正相关,与鼻阻力测值呈负相关,与外鼻亚单位测值无相关性。鼻通气主观评分与鼻阻力测值呈显著正相关,但鼻外形主观评分与外鼻亚单位测值无相关性。结论用主客观结合的方式从鼻通气功能、鼻外观美学、心理状态多角度整体综合评估,可有效评价功能性鼻整形术的疗效。     

Long-Term Evaluation in Aesthetic Rhinoplasty in an Academic Referral Center

Plastic surgery is based on improving esthetic for the patient. In most services, the surgery outcome is evaluated in a subjective manner.Aimto objectively assess the degree of patient satisfaction one year after rhinoplasty using the Rhinoplasty Outcome Evaluation questionnaire at a referral academic center.Materials and Methods69 patients operated in the otorhinolaryngology service were selected. The patients were operated upon by third year residents during the period from January to December 2007 and answered the questionnaire translated by the authors of this study.Resultswe obtained a mean value of 73.25% of satisfaction for primary rhinoplasty and a mean value of 72.02% of satisfaction for secondary rhinoplasty.Conclusionthe level of satisfaction presented by the patients was considered to be very good.     

Comparison of crushed cartilage used and not used as camouflage grafts in patients who had undergone septorhinoplasty

ObjectiveSeptorhinoplasty is the most frequently performed aesthetic operation. Many techniques are used in septorhinoplasty, and these techniques can affect patient satisfaction, which is one of the most important parameters showing success in surgery. In this study, we aimed to compare the postoperative satisfaction of patients with and without crushed cartilage onlay grafts.MethodsPatients who underwent septorhinoplasty between 2017 and 2019 were included in the study. A rhinoplasty outcomes evaluation (ROE) questionnaire and a visual analog scale (VAS) were completed before and after surgery. Pre- and postoperative values were compared. The patients were classified into two groups as patients with or without crushed cartilage grafts, and the results were compared.ResultsA total of patients were included in our study, 54 of which were female, and 39 were male. Results showed that post-operative ROE and VAS scores were statistically significantly improved (p < 0.05). In the group with crushed cartilage, the 12th month ROE and VAS scores were lower than the group without crushed cartilage (p < 0.05).ConclusionIn the group with crushed cartilage, the satisfaction levels in the 12th month were lower than those of the patients without crushed cartilage.     

A new approach for crooked nose: Separated spreader graft “puzzle graft”

IntroductionThe nasal septum takes an important role in nasal shape and function. The term “crooked nose” is commonly used for all of the clinical conditions involving deviation of the nasal axis from the midline. This situation leads to both aesthetic concerns and breathing problems. In this study, we describe a new method in order to nasal dorsum on the midline and improving airway function in crooked nose patients, that will be contribute to the literature.Materials and methodsThis study enrolled 50 (fifty) patients who had undergone open septorhinoplasty operation were included in our study. The puzzle graft, which was prepared as a spreader graft consisting of three separate parts, was used to correct crooked nose in all patients. Anterior rhinoscopic examination, photographs and Nasal Obstruction and Septoplasty Effectiveness (NOSE) scores for the pre-operative and post-operative 1 year were compared and evaluated in this study.ResultsThe new approach was used successfully in all of the patients. Anterior rhinoscopic and 1 year photographic evaluations revealed a significantly correction of external appearance post-operatively. None of the patients had any additional complaints and complications during the post-operative period. We observed that NOSE scores, with which the post-operative nasal obstruction was evaluated, were significantly better in all 50 patients.ConclusionCrooked nose deformity is one of the most difficult problems in rhinoplasty. There is no absolute true technique for solving this situation. Each method works properly in appropriate cases. Sometimes we should use more than one technique in the same operation to correct the pathology. Our purpose is to present a new option to help surgeons in “crooked nose”; to provide a new method that can work safe and effective in convenient conditions.     

Long-term patient satisfaction after revision rhinoplasty

OBJECTIVE: In cases of dissatisfaction after rhinoplasty for esthetic or functional reasons, or both, revision rhinoplasty may be advocated to improve the patients' nasal performance. In contrast to studies on primary rhinoplasty, no objective outcome evaluation parameter has been validated in revision rhinoplasty, nor has there been a study specifically looking at long-term satisfaction after revision rhinoplasty. We aim at studying patient satisfaction after a long-term follow-up of revision rhinoplasty performed at an academic referral center. METHODS: At a mean period of 2.5 years after revision rhinoplasty, 90 patients who underwent a revision rhinoplasty at the Academic Medical Center in Amsterdam, The Netherlands, were sent a questionnaire on general satisfaction together with the validated rhinoplasty outcome evaluation (ROE) questionnaire. RESULTS: Of the 46 patients who responded to the questionnaire, 88% experienced a significant improvement in nasal performance by revision rhinoplasty, and 79% would choose to undergo the revision procedure again. Subgroup analysis of the ROE scores demonstrated that good satisfaction was mainly obtained in the young adult and middle-aged groups, without major differences between males and females. Satisfaction was unrelated to the open or closed technique used for revision, or to the graft material used. Interestingly, an inverse correlation was found between satisfaction and the number of previous rhinoplasties. CONCLUSIONS: This retrospective study demonstrates that revision rhinoplasty in an academic practice provides most patients with long-standing satisfaction.     

Evaluation of the Esthetic and Functional Outcomes of Extracorporeal Septoplasty for Rhinoplasty in Asian Patients

ObjectivesIn extracorporeal septoplasty (ECS), the entire septal cartilage is harvested, and a neo-L strut is built extracorporeally. Thus, ECS can simultaneously achieve septum straightening and tip projection. This study evaluated the functional and esthetic outcomes of the ECS technique for rhinoplasty in Asian patients.MethodsWe conducted a retrospective review of 64 patients who underwent rhinoplasty using ECS between January 2016 and March 2018. Subjective patient satisfaction was assessed and objective surgical outcomes were evaluated. Improvement in nasal obstruction was rated using a visual analog scale (VAS). Anthropometric changes were compared between preoperative and postoperative facial photographs. Complications and revisions were also analyzed.ResultsThe participants comprised 64 patients (48 males and 16 females, with a mean age of 29.3 years). The mean operative time was 89.3 minutes. In total, 61 patients were satisfied with the esthetic outcome, and the overall objective rhinoplasty outcome score was 3.45. Preoperative nasal obstruction symptoms (7.9±1.2 on VAS) improved postoperatively (3.1±1.3, P<0.001), and significant improvements were also observed in the nasofrontal angle (152.3° to 148.1°, P<0.001), nasolabial angle (88.8° to 92.0°, P<0.001), and nasal tip projection (0.62 to 0.66, P<0.033). Recurrent deviation of the nasal septum and external nose or tip deprojection did not occur in any patients, and there were no cases of revision during the mean follow-up period of 13.3 months.ConclusionECS might be an esthetically and functionally satisfactory alternative rhinoplasty technique for Asian patients with a shortage of septal cartilage.     

ROE量表在外鼻畸形合并鼻中隔偏曲患者手术前后生存质量评估中的应用

目的 探讨外鼻畸形合并鼻中隔偏曲患者接受鼻内镜辅助下功能性鼻整形术后生存质量的改善情况。 方法 采用鼻整形结局评估量表(ROE)评价,对其进行信度和效度分析,采用汉译的ROE问卷对接受鼻内镜辅助下功能性鼻整形术治疗的外鼻畸形合并鼻中隔偏曲患者手术前后的分值进行比较。 结果 汉译的ROE问卷具有较好的信度和效度,外鼻畸形合并鼻中隔偏曲患者,手术前后ROE分值分别为(38.622±18.136)和(76.603±6.761),差异有统计学意义(t=14.478, P<0.001)。 结论 以ROE作为评价指标,鼻内镜辅助功能性鼻整形术治疗外鼻畸形合并鼻中隔偏曲能使患者的生存质量得以提高。     

自体软骨在外伤性歪鼻合并鼻通气障碍患者鼻整形术中的应用探讨

目的探讨自体软骨在外伤性歪鼻合并鼻通气功障碍患者鼻整形术中的使用方法和效果。方法回顾性分析2017年1月至2019年4月,在陆军军医大学大坪医院耳鼻咽喉头颈外科收治的30例鼻外伤患者的病例资料,其中男21例,女9例,年龄21~50岁,平均34.9岁,病程6 d至14年。全部患者均伴有不同程度的歪鼻畸形及鼻通气障碍,分为轻、中、重三类,其中轻度8例,中度11例,重度11例,均同期行开放性鼻整形术及鼻中隔偏曲矫正术。对于轻、中度歪鼻畸形及鼻通气障碍,采用耳软骨修饰鼻尖及加强鼻中隔软骨支撑、修饰鼻背凹陷畸形。对于重度歪鼻畸形及鼻通气障碍,将肋软骨雕刻成"Y"字型整体支架或者片状肋软骨构成2+1或4+1支架,将肋软骨支架与鼻中隔软骨尾端贯穿缝合固定,重塑加固鼻中隔支撑架及鼻小柱,避免鼻背塌陷。术前、术后测量鼻外观偏离值,并分别进行鼻外观视觉评分量表(VAS)、鼻腔通气VAS评分。采用Stata 15统计软件对术前与术后的测量数据行配对资料的t检验,VAS评分行卡方检验。结果30例患者中,3例术后出现鼻中隔血肿,经清理后正常恢复。术后随访2个月至2年,所有患者均无鼻中隔穿孔、鼻梁塌陷等并发症发生。术后治愈率为60.0%(18/30),所有患者术后歪鼻程度下降Ⅰ级,有效率为100%(30/30)。患者术后测量鼻外观偏离值低于术前,差异有统计学意义[(2.40±1.58)mm比(6.85±2.43)mm,t=8.42,P<0.001]。术后鼻外观VAS评分高于术前,差异有统计学意义[(6.60±1.16)分比(1.93±1.31)分,t=-14.59,P<0.001]。患者术后鼻腔通气VAS评分高于术前,差异有统计学意义[(6.53±1.04)分比(1.97±1.07)分,t=-16.78,P<0.001]。结论自体软骨在外伤性歪鼻合并鼻通气功障碍患者鼻整形术中使用疗效好,同期行开放性鼻整形术及鼻中隔偏曲矫正手术,可缩短治疗时间,及时改善患者鼻外观及鼻通气功能。     

鼻内镜辅助下减张法功能性鼻整形手术疗效观察

目的“减张法”是保持鼻背软骨-鼻中隔软骨复合体完整性、通过解除张力而使其居中对称的方法。本文研究鼻内镜辅助下减张法功能性鼻整形手术的主观和客观疗效。方法对67 例行鼻内镜辅助下减张法功能性鼻整形手术的鼻畸形患者临床资料进行回顾性总结分析。美学效果用电子测量尺测量和患者视觉模拟评分法。鼻阻塞改善程度用鼻阻力计测量和鼻阻塞症状评分法评估。结果34 例I型鼻畸形患者鼻畸形角度电子测量值术后（2.24±1.68）度与术前（11.94±3.17）度比较,差异具有统计学意义（P<0.001）。33 例C型鼻畸形患者鼻畸形角度电子测量值术后（177.20±5.80）度与术前（158.34±9.96）度比较,差异具有统计学意义（P<0.001）。患者主观满意度很好53 例（79.1%）,好13 例（19.4%）,一般1 例（1.5%）。术后鼻阻塞较术前明显改善,差异具有统计学意义（α=0.95,P<0.001）。术后随访期间所有患者未见并发症。结论鼻内镜下减张法功能性鼻整形手术有效、微创,适用于各种鼻畸形的治疗。     

运用自体鼻中隔软骨行外伤性鞍鼻矫形隆鼻术30例

目的：探讨运用自体鼻中隔软骨对外伤性鼻骨骨折合并鼻中隔骨折致鼻部塌陷患者行鞍鼻手术的临床疗效。方法：30例鼻外伤患者的整个修复治疗过程中,均根据其实际状况及需求,同时有单纯鼻骨,忖折复位及鼻中隔骨折清理及矫正术,并使用鼻中隔软骨进行鞍鼻的修复＇冶疗。术后对患者进行随访观察及疗效评价。结果：全部患者一期修复效果均满意。随访3～42个月,28例（93．3％）远期效果满意。结论：运用A体鼻中隔软骨对外伤性鼻骨骨折合并鼻中隔骨折致鞍鼻患者进行矫治是修复鼻外伤的有效方法,倩得临床推广。     

Gradual approach to refinement of the nasal tip: surgical results

IntroductionThe complexity of the nasal tip structures and the impact of surgical maneuvers make the prediction of the final outcome very difficult. Therefore, no single technique is enough to correct the several anatomical presentations, and adequate preoperative planning represents the basis of rhinoplasty.ObjectiveTo present results of rhinoplasty, through the gradual surgical approach to nasal tip definition based on anatomical features, and to evaluate the degree of patient satisfaction after the surgical procedure.MethodsLongitudinal retrospective cohort study of the medical charts of 533 patients of both genders who underwent rhinoplasty from January of 2005 to January of 2012 was performed. Cases were allocated into seven groups: (1) no surgery on nasal tip; (2) interdomal breakup; (3) cephalic trim; (4) domal suture; (5) shield-shaped graft; (6) vertical dome division; (7) replacement of lower lateral cartilages.ResultsGroup 4 was the most prevalent. The satisfaction rate was 96% and revision surgery occurred in 4% of cases.ConclusionThe protocol used allowed the implementation of a gradual surgical approach to nasal tip definition with the nasal anatomical characteristics, high rate of patient satisfaction with the surgical outcome, and low rate of revision.     

鼻内镜辅助下外鼻整形同期鼻中隔偏曲矫正术

目的 总结33例外鼻畸形伴鼻中隔偏曲患者施行内镜辅助下鼻整形术同期鼻中隔偏曲矫正术的临床资料,分析手术方法和术后疗效。 方法 患者均在全麻下经鼻小柱鼻前庭做切口,骨膜下暴露鼻骨及上颌骨额突,在内镜辅助下进行截骨整复并矫正鼻中隔,酌情将取出的自体鼻中隔骨质及软骨条修整后填于塌陷处或支撑鼻小柱、修整鼻尖等。术中可同期行下鼻甲成形术。随访3个月以上。 结果 全部患者术后均取得满意的整形效果,鼻腔通气良好。 结论 鼻内镜辅助下鼻整形术同期行鼻中隔偏曲矫正术效果好,无排异反应,不仅能改善鼻部外观,而且能改善鼻腔通气效果。     

Key stone plasty and asymmetric hump resection in crooked nose deformity

ObjectiveThe aim of this study is to propose a new approach in crooked nose deformity with key-stone plasty and asymmetric hump resection.MethodTwelve patients with crooked nose deformities were operated using the open rhinoplasty technique. Our method, unlike other methods, has two different steps. Following asymmetric hump resection, cartilaginous and osseous septum were cut separated at the key stone area or more caudally and fix the septum with sutures again by allowing them to slide over each other in a way that directs the septum to the midline. If there is an inability to reveal the septum, we apply a longer spreader graft to the cartilage septum side.ResultsThe mean ages were 27.4 years. The mean follow-up time of the patients was 19.1 months. No complications were observed due to this technique. This technique was effective in the treatment of all our patients with crooked nose deformities.ConclusionA novel surgical approach with key-stone plasty and asymmetric hump resection method was proposed in crooked nose deformity with a video animation.     

Postoperative nasal symptoms associated with an endoscopic endonasal transsphenoidal approach

Recent studies have indicated the usefulness of endoscopic endonasal transsphenoidal approach (EETSA). A few studies have reported on the postoperative nasal symptoms of patients who have undergone EETSA. Therefore, we adopted a rhinologic perspective to compare preoperative and postoperative nasal symptoms after performing a binostril, four-hand EETSA. Patients who were scheduled to undergo binostril, four-hand EETSA underwent preoperative nasal evaluation using the Nasal Obstruction Symptom Evaluation (NOSE), Sino-Nasal Outcome Test-20 (SNOT-20), and a visual analogue scale (VAS) to assess several nasal symptoms. Repeat testing was performed 6 months postoperatively. Paired Student’s t tests were used to compare preoperative and postoperative scores. A total of 142 patients who underwent a binostril, four-hand EETSA were included in this study. We found no statistically significant differences between preoperative and postoperative NOSE, total SNOT-20 scores, or scores on the VAS for nasal obstruction, sneezing, rhinorrhea, snoring, or facial pain. However, VAS of olfactory change increased significantly after EETSA (p < 0.05). The binostril, four-hand EETSA would be a useful method because it permits operative manipulability and a wide visual field for skull base lesions. However, rhinologists must consider postoperative nasal symptoms and perform a proper preoperative examination, especially with regard to the olfactory function, and inform patients scheduled for EETSA of potential postoperative changes.     

鼻整形术:歪鼻整形

歪鼻整形的内容涵盖了鼻的美学及功能。鼻上1/3偏曲的矫正多使用截骨术,鼻中间1/3偏曲通常使用鼻中隔矫正术修复。刻痕、切除、撑开移植物、自体组织撑开瓣等方法被用于矫正鼻背。鼻中隔尾侧偏曲通过刻痕、切除和在鼻前棘上重置鼻中隔来治疗。不同的截骨术用于不同类型的歪鼻畸形。治疗下鼻甲肥大和内鼻阈塌陷是纠正歪鼻气道功能受损的关键。鼻小柱支撑移植物、鼻尖缝合技术和鼻翼基底切除术用于修饰鼻尖和鼻翼。     

功能性鼻整形解剖学基础及进展

鼻整形按照手术目的可以分为美容性鼻整形和功能性鼻整形。功能性鼻整形是通过调整鼻部框架结构来改善鼻子的通气功能,手术过程中,外观也会发生改变。常见的功能性鼻整形病种有歪鼻、尾段鼻中隔偏曲、陈旧性鼻骨骨折、鼻软骨畸形、内外鼻瓣的塌陷和狭窄等。现将对功能性鼻整形的解剖学基础与进展作一综述,以提高对功能性鼻整形的认识。     

Evaluation of postoperative patient satisfaction after covering the nasal dorsum with upper lateral cartilage: “upper lateral closing”

Introduction

Following nasal hump removal during septorhinoplasty, the middle vault should be reconstructed to avoid functional and esthetic problems. Middle vault reconstruction, however, may result in widening of the middle vault and may need a camouflage graft to cover dorsal irregularities.