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驼峰大鼻头 🐘 隆鼻的可行性
驼峰 🦢 鼻和大鼻头是可以通过隆鼻手 🐡 术来 🌼 改善的。
驼峰鼻驼峰鼻是指鼻梁上部有明显突起的症状。隆鼻手术可以通过去除驼峰部分的骨骼 🦊 和软骨组织，重，塑鼻梁的。形状从而改善驼峰鼻
大鼻头大鼻头是指鼻尖和鼻翼肥大。隆鼻手术可以缩小鼻头，精 🍀 ，细鼻尖和鼻翼。的形状使鼻子更加精致
联合手术对于患有驼峰鼻和 🌴 大鼻头的人，可，以进行联合 🐼 隆鼻手术同时解决这两个问题。
手术过程驼峰大 🌹 鼻头隆鼻手术通常通过鼻腔 🐒 内切口进行，以避免在 🕊 鼻子上留下明显的疤痕手术。步骤包括：
切开鼻 🦋 腔内膜
去除驼峰 🐵 部分的骨骼和软骨
修整 🐦 鼻尖 🐞 和鼻翼的软骨
缝 🕸 合鼻腔 🌷 内膜
效果驼峰大鼻头隆鼻手 🌿 术的效果是显著的，可，以改善驼峰鼻和大鼻头的症状使鼻子更加美观术。后恢复期约为 12 周，期。间可能会出现肿胀和瘀青
风险 🐶 和并发 💮 症
与其 🐼 他手术一样，驼，峰大鼻头隆鼻手术也存在一定的风险和并发症包括：
感染选择经验丰富、技术娴熟的整形外科医生进行驼峰大鼻头隆鼻手术非常重要。合格的医生可以根据您的具体情况制 🌸 定手术计划，并以，安。全的方式进行手术获得理想的效果
是的，驼 🌿 峰鼻隆 🐵 鼻通常比 🕷 普通鼻子的隆鼻手术更贵。
这是因为驼峰鼻隆鼻涉及额外 🦆 的步骤来去除驼峰和塑造鼻 🦊 梁，从而需要外科医生的更多时间和技术。该，手，术。可能还需要使用人工材料如硅胶或膨体进一步增加费 🐛 用
Chang Gung Memorial Hospital, Linkou Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan, Taiwan
ChungChang Hsiao
Department of Plastic Surgery, Chang Gung Memorial Hospital, Linkou Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan, Taiwan
Correspondence
Address correspondence and reprint requests to Jiahua Chen, Department of Plastic Surgery, Chang Gung Memorial Hospital, Linkou Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, 5, Sec. 1 Fuxin St., Guishan Dist., Taoyuan City 333, Taiwan. Email:
Abstract
Background Nasal dorsum augmentation using autogenous cartilage grafts, although popularly performed, has some inherent disadvantages. Techniques utilizing alloplastic implants can be affected by unattractive outcomes, such as extrusion or unfavorable contour.
Objective To describe a novel surgical technique for augmenting the nasal dorsum utilizing “autogenous folded cartilage” (AFC) to overcome the disadvantages associated with both autogenous and alloplastic implant techniques.
Methods A total of 32 patients with dorsal nasal deformities were treated using the AFC technique between January 2006 and October 2009. After harvesting the patient's septal and auricular cartilage, the cartilage was folded and secured with absorbable sutures and placed as an onlay graft over an osseointegrated implant. The patients were evaluated preoperatively, immediately after surgery, and then every month postoperatively for up to 12 months. The nasal profile lines were compared by tracing the patient's profile photograph before and after surgery.
Results Thirtytwo noses were successfully augmented with AFC. No major complications, such as graft rejection or infection, were encountered. The mean followup was 12 months. Analysis of all 32 patients showed an average dorsal height increase of 3.3 mm with an average subcutaneous soft tissue thickness of 2.0 mm. The subjective satisfaction rate was 90.6% at 12 months.
Conclusions AFC technique combined with an osseointegrated implant allows nasal dorsum augmentation without the disadvantages of either autogenous cartilage or alloplastic implants.
Keywords autogenous cartilage; folded cartilage; nasal augmentation; rhinoplasty
Introduction
Augmentation of the nasal dorsum is a surgical procedure commonly performed in rhinoplasty. [1–3] The techniques traditionally used to augment the nasal dorsum, including autogenous cartilage grafts and alloplastic implants, have some drawbacks. Although autogenous cartilage grafts are associated with a low incidence of complications, such as resorption or infection, it is limited in quantity, especially with reoperations. [4–7] Moreover, autogenous cartilage grafts usually require extensive and timeconsuming carving and sculpting to form a proper framework, which can increase operative time and risk. In addition, autogenous cartilage grafts may lead to contour irregularity, especially if the graft is warped or thin. [8] On the other hand, alloplastic implants are widely used because of their abundance and easy modeling. However, their use is limited by the risk of complications, such as erosion, extrusion, and infection. [9–11] Even with proper positioning and instrumentation, some patients may still experience an unnatural appearance or reveal a lateral shadow under certain light conditions. [12]
To overcome the disadvantages of both autogenous cartilage and alloplastic implants, we developed a novel surgical technique utilizing “autogenous folded cartilage” (AFC) to augment the nasal dorsum. This technique provides the benefits of both autogenous cartilage and alloplastic implants while avoiding the disadvantages of each. [13,14]
Our aims were to describe the surgical techniques and present our results of this novel technique.
Methods
Patients
Between January 2006 and October 2009, 32 patients with dorsal nasal deformities were treated with AFC for nasal dorsum augmentation at Chang Gung Memorial Hospital, Linkou, Taiwan. The maletofemale ratio was 1:3.1. The average patient age was 25.5 years, ranging from 15 to 40 years. Dorsal hump reduction was combined with AFC augmentation in 12 patients.
Surgical Technique
Septal and auricular cartilage harvesting
The septal cartilage of each patient was harvested through a Killian incision. The anterior segment of the septum (approximately 15 mm) was preserved for support. The auricular cartilage was harvested with a back incision made beneath the prominence of the antihelix. Following harvest, the collected cartilage was meticulously trimmed of excess perichondrium and adipose tissue.
Cartilage folding
The harvested cartilage was folded upon itself over a 30gauge wire to simulate the thickness of the dorsum. Cartilage from the septum was used as a core and wrapped by auricular cartilage. The whole structure was then sutured together using absorbable sutures (60 Monocryl; Ethicon, Somerville, NJ) (Fig. 1).
Incision and implant placement
A transcolumellar incision was made, and a subperiosteal pocket was dissected. An osseointegrated implant (Implantech SL; Toulouse, France) was positioned over the nasal bone and the frontal process of the maxilla. The implant was secured by 12–14 microscrews (Fig. 2).
Autogenous folded cartilage placement
The AFC was shaped according to the desired dorsal contour. The AFC was placed as an onlay graft over the implant through the transcolumellar incision (Fig. 3). The caudal end of the AFC was designed to be slightly shorter to prevent compression by the upper lateral cartilage (Fig. 4).
Evaluation
The patients were evaluated preoperatively, immediately after surgery, and every month postoperatively for up to 12 months. The nasal profile lines were compared by tracing the patient's profile photograph before and after surgery to evaluate the surgical outcome. The amount of nasal dorsum elevation was determined by a straight line drawn from the nasion to the nasal tip and the highest point of the dorsum before and after surgery (Fig. 5). The thickness of the subcutaneous soft tissue at the highest point of the dorsum was measured preoperatively and postoperatively using a caliper. The patient satisfaction was rated by a questionnaire at 12 months postoperatively.
Results
A total of 32 noses were successfully augmented with AFC. No major complications, such as graft rejection or infection, were encountered. All patients had a stable result at the 12month followup. The mean followup was 12 months. Analysis of all 32 patients showed an average dorsal height increase of 3.3 mm with an average subcutaneous soft tissue thickness of 2.0 mm. The subjective satisfaction rate was 90.6% at 12 months. Representative cases are shown in Figures 6–8.
Discussion
The goal of nasal dorsum augmentation is to create a smooth structural framework that supports the overlying soft tissue. The ideal augmentation material should be biocompatible, have a natural appearance, and be easy to manipulate and secure. [15,16] Autogenous cartilage grafts have been the gold standard because they have excellent longterm results and a low rate of complications. [17–19] However, autogenous cartilage grafts are limited in both quality and quantity, especially in patients who have had previous rhinoplasties. [2,20] On the other hand, alloplastic implants have also been widely used because of their abundance and easy modeling. [1,7,12] However, alloplastic implants are associated with the risk of complications, such as extrusion, infection, and bone resorption. [10,11,21]
To overcome the disadvantages of both autogenous cartilage grafts and alloplastic implants, we developed a novel surgical technique that utilizes AFC to augment the nasal dorsum. AFC combines the advantages of both autogenous cartilage and alloplastic implants while avoiding their disadvantages. [13,14] The autogenous cartilage of the AFC provides a natural framework support for the overlying soft tissue and is less prone to warping compared with the thin alloplastic implants. To further reinforce the strength of the AFC, cartilage from the septum is used as a core and wrapped by auricular cartilage. Moreover, the use of absorbable sutures, instead of nonabsorbable materials, minimizes the risk of infection. The osseointegrated implant provides a stable foundation for the AFC and prevents the rotational or lateral displacement of the graft. In addition, the osseointegrated implant is unlikely to cause extrusion or rejection because of his special design, such as his porous surface and 360degree thread. [22,23]
In our series, we have successfully augmented nasal dorsa with AFC. The average dorsal height increase was 3.3 mm with an average subcutaneous soft tissue thickness of 2.0 mm. No major complications, such as graft rejection or infection, were encountered. The subjective satisfaction rate was 90.6% at 12 months. However, our method does have some limitations. First, the nasal dorsum augmentation with AFC cannot be a standalone procedure. It must be combined with the osseointegrated implant. Second, similar to autogenous cartilage grafts, AFC augmentation requires some carving and sculpting to shape the desired contour. In addition, AFC augmentation may not be suitable for patients having a very thick nasal skin. In these patients, a higher and wider implant should be considered.
Conclusion
AFC technique combined with an osseointegrated implant allows nasal dorsum augmentation without the disadvantages of either autogenous cartilage or alloplastic implants. This
驼峰鼻适合的鼻整形 🐯 类型 💐 ：
驼峰鼻矫正：去 🕷 除鼻背上的凸起，塑造流畅的鼻型。
综合鼻整形：除了去除驼峰，还可以同时改善鼻 🐕 尖鼻、翼 🌵 等其他鼻部缺陷。
隆鼻：驼 🐧 峰鼻的人可以通过隆鼻手术抬高鼻梁 🌺 ，同，时也可以去除驼峰使鼻子更 🐺 加立体。
鼻翼缩小：驼峰鼻往往伴有鼻翼肥大鼻翼缩小，手，术可以减小鼻翼宽度使鼻 🌸 子更加精致。