目的:探讨一种新型软骨框架——外隔片框架在东亚隆鼻中的应用及疗效。
方法:从2021年11月到2023年4月,整形和美学(烧伤)外科,湘雅二医院,中南大学,使用创新的外部间隔框架治疗41例自体肋软骨隆鼻患者。手术开放入路采用倒V形经小柱切口和边缘切口。收获第六或第七肋软骨以形成鼻小柱支撑移植物(支柱),外部鼻中隔移植物,帽移植物,和盾牌移植物,其中鼻柱支撑移植物和外部鼻中隔移植物以舌槽的方式连接以形成外部隔膜框架以支撑和延长尖端。帽状移植物用于塑造鼻尖,腹直肌筋膜用于覆盖鼻尖,屏蔽移植物用于扩大下小叶。根据鼻背的增大程度雕刻ePTFE,并将其植入背侧以增大鼻背。通过在术前和随访期间拍摄的标准面部照片评估临床结果,并使用鼻整复效果评价量表(ROE)和视觉模拟评分(VAS)定期随访完成术后满意度调查。使用配对样本t检验比较手术前后的客观和主观测量结果。P<0.05的值被认为是显著的。通过测量患者术前和术后的鼻唇沟角度来评估鼻架的客观评估结果,鼻长,和鼻尖突起。(计算前突与翼颊交界处之间的距离作为尖端投影。)术前和术后鼻唇沟角度和鼻长的比较采用配对样本t检验,鼻尖投影的比较使用Wilcoxon符号秩和检验进行配对样本的比较。P<0.05的值被认为是显著的。
结果:共治疗了41例患者,包括9名男性和32名女性,年龄从17岁到48岁(32.8±1.5岁),在研究中,平均随访时间为19.85±4.88个月(12~29个月).没有观察到长期或短期并发症。所有病例的美学结果,如鞍形鼻子,偏离的鼻小柱,鼻子的双侧不对称,双侧鼻底凹陷,球根状尖端令人满意。患者满意度评价:术前ROE量表为(11.85±2.46),术后ROE量表为(17.43±2.15)。术前VAS评分为(4.86±1.60),术后VAS评分为(8.48±1.25)。患者间ROE量表和VAS评分差别有统计学意义(P<0。05),88.9%的患者在这些手术后感到满意。就鼻唇沟角度而言,41例患者术前、术后测量值分别为(86.11±2.25)°和(98.66±1.90)°,分别,鼻唇沟角度差异有统计学意义(P<0.05);术前鼻长为39.43±1.55mm(37.95~43.51mm),术后为42.17±1.46mm(40.23~45.62mm);在鼻尖突起方面,术前和术后测量的中位数分别为1.84(1.73,2.01)cm和2.15(2.02,2.32)cm,术前、术后值差异有统计学意义(P<0.05)。
结论:创新的软骨框架-外部间隔框架,避免了间隔的解剖和间隔软骨的吸收与ESG的压缩,很容易执行,它也是稳定和强大的,以实现良好的美学效果。
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OBJECTIVE: To investigate the application and therapeutic efficacy of a novel cartilage framework: the external septa framework in East Asian rhinoplasty.
METHODS: From November 2021 to April 2023, Department of Plastic and Aesthetic (Burn) Surgery, the Second Xiangya Hospital, Central South University, treated 41 patients with autologous costal cartilage rhinoplasty using an innovation external septal framework. The surgical open approach used an inverted V-shaped trans-columellar incision and marginal incision. The sixth or seventh costal cartilage was harvested to form the nasal columella support grafts (strut), external nasal septal graft, cap grafts, and shield grafts, in which the nasal column support graft and external nasal septal graft are connected in a way of tongue in groove to form a external septum framework to support and lengthen the tip. A cap graft is used to shape the tip of the nose, the rectus abdominis fascia is used to cover the tip of the nose, and the shield grafts are used to augment the inferior lobules. ePTFE was sculpted according to the degree of augment of the nasal dorsum and implanted on the dorsal to augment the nasal dorsum. Clinical outcomes were assessed through standard facial photographs taken during the preoperative and follow-up periods, and a postoperative satisfaction survey was completed with regular follow-up using the rhinoplasty outcome evaluation scale (ROE) and visual analogue scale (VAS). Results of objective and subjective measurements before and after surgery were compared utilizing paired-sample t tests. Values of P < 0.05 were considered significant. Nasal framework\'s objective evaluation outcomes were assessed by measuring the patients\' preoperative and postoperative nasolabial angle, nasal length, and nasal tip projection. (The distance between the pronasale and the alar-cheek junction was calculated as the tip projection.) The comparison of preoperative and postoperative nasolabial angle and nasal length was performed using the paired-sample t test, and the comparison of nasal tip projection was performed using the Wilcoxon signed rank-sum test for the comparison of paired samples. Values of P < 0 .05 were considered significant.
RESULTS: A total of 41 patients were treated, including 9 males and 32 females, ranging in age from 17 to 48 years(32.8 ± 1.5 years old), In the study, an average follow-up period of 19.85 ± 4.88 months was observed (range 12-29 months). There was no long-term or short-term complication observed. The aesthetic outcome of all cases such as saddle nose, deviated nasal columella, bilateral asymmetry of the nose, bilateral nasal base depression, and bulbous tip was satisfactory. Patient satisfaction evaluation: The ROE scale was (11.85 ± 2.46) preoperatively and (17.43 ± 2.15) postoperatively. The VAS scores were (4.86 ± 1.60) preoperatively and (8.48 ± 1.25) postoperatively. The difference of ROE scale and VAS scores among the patients was statistically significant (P < 0. 05), and 88.9% of patients were satisfied following those procedures. In terms of nasolabial angle, preoperative and postoperative measurements of 41 patients were (86.11 ± 2.25)° and (98.66 ± 1.90)°, respectively, and the difference of nasolabial angle was statistically significant (P < 0.05); nasal length measurements were 39.43 ± 1.55 mm (37.95-43.51 mm) preoperatively and 42.17 ± 1.46 mm (40.23-45.62 mm) postoperatively; in terms of nasal tip projection, preoperative and postoperative measurements of median values were 1.84(1.73,2.01) cm and 2.15(2.02,2.32) cm, respectively; and the difference between preoperative and postoperative values was statistically significant (P < 0.05).
CONCLUSIONS: The innovative cartilage framework-external septal framework, avoids the dissection of septa and absorption of septal cartilage with compression of ESG, it is easy to be performed, and it is also stable and strong to achieve in good aesthetic result.
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