目的鼻成形术,在保留或增强鼻气道的同时改变鼻子形状或外观的外科手术,在美国最常见的整容手术中排名,2014年报告的程序>200,000例。虽然很难计算手术后有或没有并发症的隆鼻患者所承受的确切经济负担,平均隆鼻手术通常超过4000美元。因并发症而产生的费用,感染,或翻修手术可能包括长期抗生素的费用,住院治疗,或因误工数小时/天而损失的收入。隆鼻的心理影响也可以是显著的。此外,来自鼻畸形/美学缺陷的心理压力的医疗保健负担,外科感染,手术疼痛,抗生素的副作用,和鼻腔填塞材料也必须考虑这些患者。在此准则之前,关于术前和术后管理的标准护理考虑因素以及确保接受隆鼻手术的患者获得最佳结果的标准手术实践的文献有限.本指南的推动力是利用当前的循证医学实践和数据来建立关于围手术期和术后策略的一致性,以最大程度地提高患者安全性并优化患者的手术结果。目的本指南的主要目的是为进行鼻整形或参与鼻整形治疗的临床医生提供循证建议。以及优化患者护理,促进有效的诊断和治疗,并减少有害或不必要的护理变化。目标受众是任何临床医生或个人,在任何设置中,参与这些患者的管理。目标患者群体是所有年龄≥15岁的患者。该指南旨在关注知识差距,实践变化,以及与此手术程序相关的临床问题;它不旨在成为改善鼻整理术后鼻形态和功能的综合参考。本指南中关于患者教育和咨询的建议也旨在包括患者<18岁时的护理人员。行动声明指南开发小组提出了以下建议:(1)临床医生应询问所有寻求隆鼻手术的患者手术动机和对结果的期望,应该就这些期望是否是手术的现实目标提供反馈,并应将此讨论记录在病历中。(2)临床医生应评估可能修改或禁忌症手术的共病条件的鼻整理术候选人,包括阻塞性睡眠呼吸暂停,身体畸形,出血性疾病,或长期使用局部血管收缩鼻内药物。(3)外科医生,或外科医生的指定人员,术前评估时,应评估鼻整复治疗鼻气道阻塞的候选方案。(4)外科医生,或外科医生的指定人员,应该教育隆鼻术候选人关于手术后的期望,手术如何影响鼻子呼吸的能力,手术的潜在并发症,以及未来鼻部手术的可能需要。(5)临床医生,或临床医生的指定人员,应就手术对鼻气道阻塞的影响以及阻塞性睡眠呼吸暂停可能如何影响围手术期管理,向有记录的阻塞性睡眠呼吸暂停的鼻整形候选人提供建议.(6)外科医生,或外科医生的指定人员,应在手术前对隆鼻患者进行治疗,以应对手术后的不适。(7)临床医生应在鼻整治后至少12个月内记录患者对其鼻外观和鼻功能的满意度。指南发展小组针对某些行动提出了建议:(1)当外科医生,或外科医生的指定人员,选择使用围手术期抗生素进行隆鼻手术,他或她不应在手术后>24小时内常规开抗生素治疗.(2)手术结束时,外科医生不应常规地将填塞物放置在隆鼻患者(有或没有鼻中隔成形术)的鼻腔中。专家组做出以下声明是一种选择:(1)外科医生,或外科医生的指定人员,可对隆鼻患者给予围手术期全身性类固醇。
Objective Rhinoplasty, a surgical procedure that alters the shape or appearance of the nose while preserving or enhancing the nasal airway, ranks among the most commonly performed cosmetic procedures in the United States, with >200,000 procedures reported in 2014. While it is difficult to calculate the exact economic burden incurred by rhinoplasty patients following surgery with or without complications, the average rhinoplasty procedure typically exceeds $4000. The costs incurred due to complications, infections, or revision surgery may include the cost of long-term antibiotics, hospitalization, or lost revenue from hours/days of missed work. The resultant psychological impact of rhinoplasty can also be significant. Furthermore, the health care burden from psychological pressures of nasal deformities/aesthetic shortcomings, surgical infections, surgical pain, side effects from antibiotics, and nasal packing materials must also be considered for these patients. Prior to this guideline, limited literature existed on standard care considerations for pre- and postsurgical management and for standard surgical practice to ensure optimal outcomes for patients undergoing rhinoplasty. The impetus for this
guideline is to utilize current evidence-based medicine practices and data to build unanimity regarding the peri- and postoperative strategies to maximize patient safety and to optimize surgical results for patients. Purpose The primary purpose of this
guideline is to provide evidence-based recommendations for clinicians who either perform rhinoplasty or are involved in the care of a rhinoplasty candidate, as well as to optimize patient care, promote effective diagnosis and therapy, and reduce harmful or unnecessary variations in care. The target audience is any clinician or individual, in any setting, involved in the management of these patients. The target patient population is all patients aged ≥15 years. The guideline is intended to focus on knowledge gaps, practice variations, and clinical concerns associated with this surgical procedure; it is not intended to be a comprehensive reference for improving nasal form and function after rhinoplasty. Recommendations in this
guideline concerning education and counseling to the patient are also intended to include the caregiver if the patient is <18 years of age. Action Statements The
Guideline Development Group made the following recommendations: (1) Clinicians should ask all patients seeking rhinoplasty about their motivations for surgery and their expectations for outcomes, should provide feedback on whether those expectations are a realistic goal of surgery, and should document this discussion in the medical record. (2) Clinicians should assess rhinoplasty candidates for comorbid conditions that could modify or contraindicate surgery, including obstructive sleep apnea, body dysmorphic disorder, bleeding disorders, or chronic use of topical vasoconstrictive intranasal drugs. (3) The surgeon, or the surgeon\'s designee, should evaluate the rhinoplasty candidate for nasal airway obstruction during the preoperative assessment. (4) The surgeon, or the surgeon\'s designee, should educate rhinoplasty candidates regarding what to expect after surgery, how surgery might affect the ability to breathe through the nose, potential complications of surgery, and the possible need for future nasal surgery. (5) The clinician, or the clinician\'s designee, should counsel rhinoplasty candidates with documented obstructive sleep apnea about the impact of surgery on nasal airway obstruction and how obstructive sleep apnea might affect perioperative management. (6) The surgeon, or the surgeon\'s designee, should educate rhinoplasty patients before surgery about strategies to manage discomfort after surgery. (7) Clinicians should document patients\' satisfaction with their nasal appearance and with their nasal function at a minimum of 12 months after rhinoplasty. The
Guideline Development Group made recommendations against certain actions: (1) When a surgeon, or the surgeon\'s designee, chooses to administer perioperative antibiotics for rhinoplasty, he or she should not routinely prescribe antibiotic therapy for a duration >24 hours after surgery. (2) Surgeons should not routinely place packing in the nasal cavity of rhinoplasty patients (with or without septoplasty) at the conclusion of surgery. The panel group made the following statement an option: (1) The surgeon, or the surgeon\'s designee, may administer perioperative systemic steroids to the rhinoplasty patient.