膨体聚四氟乙烯在鼻成形术中的临床应用

目的　为了探讨膨体聚四氟乙烯 (ePTFE)较目前运用其它材料行鼻成形术的优越性。方法　从 1998年7月至 1999年 5月 ,18例患者利用ePTFE行鼻成形术 ,包括鼻背增高、鼻尖成形和鼻部软组织凹陷畸形的矫正。结果　经过 4周至 10个月的随访 ,除 1例术后效果不满意而取出假体外 ,其余均获得满意效果。结论　在鼻成形术中 ,ePTFE是一种理想的组织替代品。ePTFE加强型补片尤其适用于鼻尖部的整形     

Labiocolumellar Graft Combined with Tip Graft in the Management of Inadequate Tip Projection

The short distance of the nasal tip from the alar crease indicates inadequate projection. Tip grafts are commonly used for the management of this problem. In addition to tip grafts, labiocolumellar augmentation by cartilage grafts also provides further elevation of the tip complex for patients with poor tip definition, excessive alar base width, inadequate tip projection, or plunging nasal tip. In addition to standard rhinoplasty procedure and tip grafting for nasal tip augmentation, a linear cartilage graft was inserted centrally just behind the labiocolumellar angle for further tip elevation. The graft was placed in the subdermal plane just anterior to the orbicularis oris muscle to prevent graft displacement and clicking during muscle motion. This procedure was performed for 45 rhinoplasty patients, only three of whom underwent tip plasty procedures alone. During 1 year, 43 patients were followed up. Most of the patients (75%) were satisfied with the results of the procedure. Tip graft combined with labiocolumellar graft is an effective technique for obtaining satisfactory tip projection and correcting the acute labiocolumellar angle. Presented at The XVI. Congress of ISAPS, 26–29 May 2002, Istanbul, Turkey, and should be attributed to Department of Plastic and Reconstructive Surgery, Cerrahpasa School of Medicine, Istanbul University, and Haseki Hospital, Department of Otolaryngology Istanbul, Turkey.     

The caudal septum replacement graft

OBJECTIVE: To describe a technique for reconstructing the lost tip support in cases involving caudal septal and premaxillary deficiencies. METHODS: The study included 120 patients with aesthetic and functional nasal problems resulting from the loss of caudal septal and premaxillary support. An external rhinoplasty approach was performed to reconstruct the lost support using a cartilaginous caudal septum replacement graft and premaxillary augmentation with Mersilene mesh. RESULTS: The majority of cases (75%) involved revisions in patients who had previously undergone 1 or more nasal surgical procedures. A caudal septum replacement graft was combined with premaxillary augmentation in 93 patients (77.5%). The mean follow-up period was 3 years (range, 1-12 years). The technique succeeded in correcting the external nasal deformities in all patients and resulted in a significant improvement in breathing in 74 patients (86%) with preoperative nasal obstruction. There were no cases of infection, displacement, or extrusion. CONCLUSIONS: The caudal septum replacement graft proved to be very effective in restoring the lost tip support in patients with caudal septal deficiency. Combining the graft with premaxillary augmentation using Mersilene mesh helped increase support and stability over long-term follow-up.     

鼻中隔软骨联合自体真皮组织在鼻综合整形术中的应用

目的探讨应用鼻中隔软骨行鼻尖塑形,并联合采用自体真皮组织隆鼻的临床疗效。方法本组36例求美者均采用鼻小柱开放式切口,应用自体鼻中隔软骨,根据需要做鼻小柱支撑物、鼻尖移植物或鼻中隔延伸移植物;于臀下皱襞处取真皮组织瓣,去除表皮及皮下脂肪,切开真皮,缝合成多层置于鼻背筋膜下,妥善固定。结果36例求美者术后无切口感染裂开及软骨外露,鼻外形自然饱满,鼻尖表现点明显,侧面观弧线圆润。术后随访3个月至2年,切口无明显瘢痕增生,鼻外形无显著变化,效果满意。结论鼻中隔软骨联合自体真皮组织移植是综合鼻整形中的有效方法,值得临床推广应用。     

Use of costal cartilage cantilever grafts in negroid rhinoplasties

Dorsal augmentation and nasal tip refinement are important objectives in Negroid rhinoplasty. Use of a costal cartilage cantilever graft will achieve these objectives. We report on our experience in 19 patients. The technique offers an excellent solution to supplying the large amount of material often required to adequately augment the dorsum in these patients. The graft is also versatile enough to allow nasal tip refinement. There are additional aesthetic benefits as the cantilever causes a lengthening in the nasal columella, a reduction in the flare of the nostrils, and increases the columellar-labial angle. The procedure is relatively simple to perform. The problem of warping is minimized by symmetrical carving and the use of large grafts with a substantial cross-section.     

The extended columellar strut-tip graft

The extended columellar strut-tip graft is a structural unit used in endonasal rhinoplasty that combines the attributes of the columellar strut and the tip graft. It is used to provide projection and contour to the nasal tip. Our goal with this study was to evaluate a 15-year experience with 155 patients who underwent rhinoplasty with the extended columellar strut-tip graft. Of these, 110 underwent secondary rhinoplasty, and 45 underwent primary rhinoplasty. There were 6 patients in the secondary rhinoplasty group who experienced complications: in 3, the graft became visible postoperatively, and 3 patients had graft placement asymmetry. These 6 patients underwent surgery in the initial years of graft development. One patient with graft edge visibility and 1 patient with graft asymmetry underwent revision surgery with satisfactory results. The extended columella strut-tip graft is a reliable method to provide nasal tip projection and contour. The successful use of the graft requires precise diagnosis and surgical technique.     

非吸收材料与吸收材料注射隆鼻后的塑形效果比较

目的 比较非吸收材料与吸收材料注射隆鼻后的塑形效果。方法 选取2019年10月-2022年10月 于我院行隆鼻术的85例患者为研究对象，以随机数字表法分为对照组（n =42）与研究组（n =43）。对照 组给予吸收材料瑞兰注射，研究组给予非吸收材料爱贝芙注射，术后随访6个月，比较两组塑形效果、 鼻外观改变情况、美学达标率、不良反应发生率及满意度。结果 研究组术后6个月隆鼻后综合评分 高于对照组（P ＜0.05）；研究组术后6个月鼻尖角、鼻尖高度及鼻长均优于对照组（P ＜0 . 0 5）； 研究组鼻额角、鼻面角、鼻尖突出度及鼻唇角的美学达标率均高于对照组（P＜0.05）；研究组不 良反应发生率为4.65%，低于对照组的21.43%（P＜0.05）；研究组满意度为95.35%，高于对照组的 78.57%（P ＜0.05）。结论 非吸收材料注射隆鼻后的塑形效果及美学效果均优于吸收材料，能够有效改善 鼻外观，且不良反应较少，患者满意度较高。     

The decision process in choosing costal cartilage for use in revision rhinoplasty

The aims of rhinoplasty reconstruction include maintaining or augmenting long-term tip projection, restoring rigid dorsal stability, and restoring optimum respiratory function. The methods set forth to obtain these objectives are inherently based on the intrinsic nasal principles at the time of the rhinoplasty. Because of the excellent and consistent results autologous costal cartilage grafts provide when faced with problems such as the traumatic saddle deformity, defects after neoplastic resection, congenital nasal deformities, severe tip weakness or underprojection, rhinoplasty in the ethnic patient, and revision rhinoplasty, they are an invaluable resource to the rhinoplasty surgeon. Once the surgeon becomes comfortable and proficient at harvesting this graft, it inevitably will become the graft of choice when substantial amounts of cartilage are required.     

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。     

Augmentation of nasal tip projection using the inferior turbinate: review of technique and evaluation of long-term success

OBJECTIVES: To introduce the use of inferior turbinate bone as an alternative autograft for augmentation of nasal tip projection and to assess maintenance of nasal tip projection, bone remodeling, graft shaping, and ease of harvesting. METHODS: Thirteen consecutive patients in need of increased nasal tip projection underwent closed rhinoplasty during a prospective nonrandomized study in a university teaching hospital setting. An autologous demucosalized inferior turbinate bone graft was used as a columellar strut. Measurements of nasal tip projection were obtained using the Goode ratio. Photodocumentation and lateral soft tissue radiographs were obtained before surgery and between 30 and 38 months after surgery. RESULTS: In all patients, the results were as follows: (1) the inferior turbinate bone graft was easily harvested and molded into the appropriate-sized columellar strut; (2) the immediate postoperative nasal tip projection, as measured by the Goode ratio and visual assessment, was increased; and (3) the tip projections were maintained at the 30-month follow-up examination. Paired t tests revealed a statistically significant difference (P = .001 and P = .009) between preoperative and both immediate and long-term measurements. Comparison of immediate postoperative radiographs with those taken 2 years later demonstrated no remarkable change in appearance of the graft. CONCLUSIONS: The interior turbinate bone is a viable graft for augmenting nasal tip projection. Moreover, it maintains tip projection and needs little to no remodeling. The graft is easy to harvest, prepare, and place and can be used without requiring a second operative site.     

Nasal Tip Plasty Using Various Techniques in Rhinoplasty

Rhinoplasty is one of the most common aesthetic surgical procedures in Korea today. However, simple augmentation rhinoplasty results often failed to satisfy the high expectations of patients. As a result, many procedures have been developed to improve the appearance of the nasal tip and nasal projection. However, the characteristics of Korean nasal tips including the bulbous appearance (attributable to the thickness of the skin), flared nostrils, and restriction of the nasal tip attributable to an underdeveloped medical crus of the alar cartilage and a short columella have made such procedures difficult. Currently, most plastic surgeons perform rhinoplasty simultaneously with various nasal tip plasty techniques to improve the surgical results. An important part of an aesthetically pleasing result is to ensure an adequate nasal tip positioned slightly higher than the proper dorsum, with the two tip defining points in close proximity to each other, giving the nose a triangular shape from the caudal view. From June 2002 to November 2003, the authors performed rhinoplasty with simultaneous nasal tip plasty using various techniques according to the tip status of 55 patients (25 deviated noses, 9 broad noses, 15 low noses, and 6 secondary cleft lip and nose deformities). The surgery included realignment of alar cartilage by resection and suture, fibroareolar and subcutaneous tissue resection, tip graft, and columellar strut. The postoperative results over an average period of 10 months were entirely satisfactory. There were no patient complaints, nor complications resulting from the procedures. Good nasal tip projection, natural columellar appearance, and improvement of the nasolabial angle were achieved for most patients. In conclusion, rhinoplasty with simultaneous nasal tip plasty, achieved by a variety of techniques according to patients tip status, is an effective method for improving the appearance of the nose and satisfying the desires of the patients.     

Correction of the nasal tip and columella in Koreans by a complete septal extension graft using an extensive harvesting technique.

The nose of most Koreans is characterised by a low nasal dorsum, retracted columella, and an acute columella-labial angle. For the surgical correction of the tip and columella, a complete septal extension graft, along with augmentation rhinoplasty has been developed. However, the use of this type of graft is frequently problematic because the septal cartilage is not large enough. In a study involving 10 cadavers, a complete septal extension graft was achieved in two of them by using septal cartilage harvested according to standard techniques. Therefore, the septal cartilage was harvested, leaving a 5-mm L-shaped strut, and a complete septal extension graft was implanted. The present report describes the results obtained in 34 patients and offers an analysis of the results as judged by the columella-labial angle and three proportional indices (nose height index, nasal bridge length index, and nasal tip projection index), measured by photogrammetry. The postoperative values obtained in these four categories increased significantly compared to the preoperative ones, thus confirming that the projection of tip was augmented, the nose was lengthened, and the columella was advanced caudally. Moreover, these positive outcomes were maintained during long-term follow-up, and no side effects, such as saddle nose deformity, were reported.     

λ-Shaped Implant for Augmentation of Anterior Nasal Spine in Asian Rhinoplasty as an Ancillary Procedure

There is often a preexisting acute columella-labial angle in Asian noses and in most of these cases, the nasal spine is underdeveloped or sometimes even absent. Moreover, nasal tip projection by a tip graft or cephalic rotation of the nasal tip may get worse at the retracted columella-labial junction in the Asian nose with an underdeveloped anterior nasal spine, thus requiring the use of a maxillary spine graft or an implant. In many instances, however, the ideal source of autogenous tissue may not be available or the donor site for these tissues may be objectionable. So I have designed the λ-shaped silicone implant for augmenting the underdeveloped anterior nasal spine (ANS) to correct the acute columella-labial angle. From March, 1996 until September, 1999, I have done ANS augmentations using the λ-shaped silicone implant in Asian rhinoplasty on 37 female patients. The correction of an acute columella-labial angle was readily accomplished by application of the λ-shaped implant using the unilateral intranasal approach. The author suggests that ANS augmentation with the λ-shaped implant is a simple and effective method as an ancillary procedure in Asian rhinoplasty providing esthetically pleasing results in properly selected Asian patients.     

鼻翼外侧真皮脂肪复合组织在鼻翼缩小合并鼻尖成形术中的应用

目的：探讨鼻翼缩小术后切除组织所形成的真皮脂肪复合组织用于鼻尖成形术的可行性及效果分析。方法：对要求同时行鼻翼缩小及鼻尖成形术的就医者,去除双侧鼻翼外侧切除组织表皮,剩余真皮及皮下组织经整修后,移植于鼻尖皮下,使鼻尖获得满意的高度和突出度,并对此类就医者实行定期随访。结果：2006年6月～2010年3月共有18名就医者接受了该项手术,通过3个月～2年的随访,所有就医者对术后效果皆十分满意,无一例并发症出现。结论：应用鼻翼外侧真皮脂肪复合组织的鼻翼缩小合并鼻尖成形术简单易行,效果良好,是一种安全可靠的手术方式。     

Dacron implants in rhinoplasty: a review of 136 cases of tip and dorsum implants

The achievement of successful results in rhinoplasty may require the use of autografts, homografts, or alloplastic materials. Among the alloplasts, Dacron is an easily handled and manipulated synthetic material, readily applicable to nasal augmentation. The following represents the indications, surgical technique, outcome results, and analysis of our experience with Dacron mesh implants to the nasal tip, dorsum, and lateral walls in 136 patients.     

隆鼻术中鼻尖整复的体会

目的：为使鼻尖低平或鼻小柱下垂者在隆鼻术中达到更好的效果。方法：对65例患者在隆鼻术的同时利用自体的鼻翼软骨进行界尖抬高,通过切除部分中隔软骨进鼻算小柱下垂的繁复。结果：经随访一周至半年,效果满意。结论：本文所述方法简单易行,并发症少,患者容易接受,术后外形自然。     

自体筋膜脂肪组织片移植在鼻尖成形中的应用

目的：研究自体筋膜脂肪组织片移植在鼻尖成形中的应用。方法：2005年1月～2008年11月,对226例鼻尖低平宽大或鼻尖皮肤菲薄的患者进行手术,通过将自体筋膜脂肪组织片固定于雕刻好的人工鼻假体鼻尖部,联合植入隆鼻腔隙,形成更为自然的鼻尖。结果：随访6月～2年鼻尖效果均满意,此方法使鼻尖外形更加自然柔美,手感良好,并且无鼻假体外露等并发症发生。结论：采用自体筋膜脂肪组织片移植结合人工隆鼻材料手术进行鼻尖部整形是一种全新的手术方法,具有供区隐蔽,取材方便,同时组织相容性好,安全性高,外形自然美观等优点。     

The Use of Expanded Polytetrafluoroethylene (Gore-Tex) in Rhinoplasty

Background Septal cartilage still is the most appropriate graft material used in rhinoplasty. In traumatic or revision cases, septal cartilage can be insufficient, and the need for an implant material emerges. In this study, the safety and efficacy of polytetrafluoroethylene (Gore-Tex) used as an implant material in nasal dorsal augmentation were assessed. Methods This study retrospectively reviewed 74 patients who underwent nasal dorsal augmentation with Gore-Tex. Of the 74 patients who underwent rhinoplasty with Gore-Tex for dorsal augmentation from February 1999 to January 2006, 46 (62.2%) represented primary cases and 28 (37.8%) represented revision cases. The patients were followed from 5 to 62 months (average, 28 months) and questioned about cosmetic and functional outcomes. The results were assessed according to patients’ charts as well as preoperative and postoperative photographic documentation. Results There were no complications such as infections, foreign body reaction, extrusions, resorption, or migration, and all the patients were satisfied with their results. Only one case of soft tissue reaction was observed, which lasted for 3 weeks postoperatively. Conclusions Biocompatibility, ease of use, lack of extrusion or resorption, and low rate of infection make Gore-Tex a good alternative to autogenous tissue. However, long-term success and complication rates still are lacking, and large numbers of patients with longer follow-up periods are required.     

羟基磷灰石微粒人工骨隆鼻术50例八年随访

为探讨羟基磷灰石（简称ＨＡ）微粒人工骨作为隆鼻术移植材料的远期效果，对ＨＡ人工骨植入隆鼻的５０例受术者进行了８年随访观察。通过受术者对手术效果的自我评价，临床医师对术后有关指标的客观检查，同时通过Ｘ线片对ＨＡ置入体的位置，形态及与鼻骨的关系进行了观察分析，随访观察的结果表明，ＨＡ微粒人工骨隆鼻术手术效果良好，ＨＡ作为隆鼻术的充填材料远期疗效稳定，是一种理想的具有生物活性的新型隆鼻材料。     

闭合式入路自体肋软骨颗粒移植隆鼻术的美学效果

目的 探讨闭合式入路自体肋软骨颗粒移植隆鼻术的美学效果。方法 选择2019年10月-2022年 10月我院收治的90例隆鼻患者为研究对象，根据采用术式的不同分为对照组和研究组，每组45例。对照 组实施膨体聚四氟乙烯假体植入隆鼻，研究组实施闭合式入路自体肋软骨颗粒移植隆鼻，比较两组美学 效果、鼻面角度相关指标、并发症发生率及患者满意度。 结果 研究组美学总有效率为95.56%，高于对照 组的77.78%，差异有统计学意义（P＜0.05）；研究组术后6个月鼻额角、鼻面角与鼻尖凸度均高于对照 组，差异有统计学意义（P＜0.05）；研究组并发症发生率为4.44%，低于对照组的17.78%，差异有统计学 意义（P＜0.05）；研究组患者满意度为95.56%，高于对照组的77.78%，差异有统计学意义（P＜0.05）。 结 论 与膨体聚四氟乙烯假体植入隆鼻术相比，闭合式入路自体肋软骨颗粒移植隆鼻术更有利于提高美学效 果，改善患者鼻面角度相关指标，降低并发症发生率，提升患者满意度，值得临床应用。