埋线隆鼻对鼻背软组织及再次鼻整形的影响研究

Study on the influence of buried thread nasal augmentation on dorsal soft tissue of noseand revision rhinoplasty

目的探讨埋线隆鼻对鼻背软组织和再次鼻整形的影响。方法回顾性分析2017年7月—2019年7月收治且符合选择标准的29例埋线隆鼻术后再次鼻整形患者临床资料。患者均为女性;年龄18~43岁,平均26.8岁。埋线隆鼻术后3~48个月入院,中位时间15个月。其中,鼻尖突度不足18例、鼻根突度不足22例、线材异位7例、线材外露5例、感染3例,10例存在2种及以上情况。合并短鼻畸形9例,鼻部存在鼻尖球形肥大1例、鼻小柱偏斜3例、鼻翼基底过宽3例、驼峰1例。3例感染患者仅行取线和清创手术;其余26例均再次鼻整形,鼻背均使用聚四氟乙烯假体,16例取自体肋软骨和耳软骨、10例取自体鼻中隔软骨和耳软骨行鼻尖整形术。将术中取出的线材及周围组织标本行组织学观察。术后测量鼻长度及鼻尖突度并计算比值,以评价鼻部形态;采用Likert 5级评分法评价患者满意度。结果患者术后均获随访,随访时间12~48个月,平均18个月。术后3例感染患者炎症控制。其余26例再次鼻整形者术后即刻即获得满意效果,术前及术后7 d、6个月,鼻长度分别为(4.11±0.34)、(4.36±0.25)、(4.33±0.22)cm,鼻尖突度分别为(2.34±0.25)、(2.81±0.18)、(2.76±0.15)cm,鼻尖突度/鼻长度比值分别为0.57±0.08、0.65±0.05、0.64±0.04。其中,鼻长度及鼻尖突度手术前后各时间点间差异均有统计学意义(P<0.05);鼻尖突度/鼻长度比值术后与术前比较差异有统计学意义(P<0.05),术后7 d与6个月间差异无统计学意义(P>0.05)。手术满意度Likert评分为1.5~5.0分,平均4.05分。26例患者随访期间均无鼻假体外露,鼻部形态稳定,5例线材外露患者鼻部皮肤可见不同程度瘢痕;未发生感染、软骨吸收以及软骨变形、移位及外露。组织学观察示可吸收性线材植入后不仅被吸收,而且随时间延长线材分解吸收引起的周围组织炎症反应呈先加重,6~12个月最严重,之后逐渐减轻趋势。结论可吸收性线材植入鼻背皮下组织后,因性质与人体组织不同,会影响鼻背皮肤软组织顺应性。线材降解、吸收会刺激周围组织炎症细胞浸润、成纤维细胞增生进而形成瘢痕组织,会影响再次鼻整形设计及效果。

Objective To investigate the influence of buried thread nasal augmentation on dorsal soft tissue ofnose and revision rhinoplasty.Methods A clinical data of 29 patients requesting revision rhinoplasty after buried thread nasal augmentation,who were admitted between July 2017 and July 2019 and met the selection criteria,was retrospectivelyanalyzed.All patients were female with an average age of 26.8 years(range,18-43 years).The patiens were admitted to thehospital at 3-48 months after buried thread nasal augmentation(median,15 months).Among them,there were 18 cases ofinsufficient nasal tip projection,22 cases of insufficient nasal root projection,7 cases of threads ectasia,5 cases of threadsexposure,3 cases of infection,and 10 cases with two or more conditions.There were 9 cases of combined short nosedeformity,1 case of spherical hypertrophy of the nasal tip,3 cases of deviation of the nasal columella,3 cases of excessivewidth of the nasal base,and 1 case of nasal hump.Three infected patients only underwent threads removal anddebridement.The rest patients underwent revision rhinoplasty,and the dorsum of the nose was made withpolytetrafluoroethylene expansion;the tip of the nose was reshaped by taking autologous rib cartilage and alar cartilage in16 cases,and by taking autologous septal cartilage and alar cartilage in another 10 cases.The threads and surroundingtissue specimens removed during operation were subjected to histologic observation.Nasal length and nasal tip projectionwere measured after revision rhinoplasty and the ratio was calculated to evaluate the nasal morphology;patientsatisfaction was evaluated using the Likert 5-grade scale.Results Patients were followed up 12-48 months(mean,18months).Inflammation was controlled in 3 patients with infections caused by buried thread nasal augmentation.Theremaining 26 patients had satisfactory results immediately after revision rhinoplasty.Before revision rhinoplasty and at7 days and 6 months after revision rhinoplasty,the nasal length was(4.11±0.34),(4.36±0.25),and(4.33±0.22)cm,respectively;the nasal tip projection was(2.34±0.25),(2.81±0.18),and(2.76±0.15)cm,respectively;and the nasal tipprojection/nasal length ratio was 0.57±0.08,0.65±0.05,and 0.64±0.04,respectively.There were significant differences inthe nasal length and the nasal tip projection between time points(P<0.05).There was a significant difference in the nasaltip projection/nasal length ratio between pre-and post-operation(P<0.05),but there was no significant difference between7 days and 6 months after operation(P>0.05).The Likert score for satisfaction ranged from 1.5 to 5.0(mean,4.05).Duringfollow-up period of 26 patients,no nasal prosthesis was exposed,and the shape of the nose was stable,and the nasal skin of5 patients with exposed threads could be seen with different degrees of scarring;there was no infection,cartilageresorption,and no cartilage deformation,displacement,or exposure.Histological observation showed that absorbablethreads were not only absorbed after implantation,but also with the prolongation of time,the inflammatory changes inthe surrounding tissues caused by decomposition and absorption of the threads showed a gradual aggravation of the first,the heaviest inflammatory reaction in 6 to 12 months,and then gradually reduce the trend.Conclusion Afterimplantation of the absorbable thread into the subcutaneous tissue of the nasal dorsum,the nature of the thread isdifferent from the body’s own tissue,which will affect the soft tissue compliance of the nasal dorsum.The degradation andabsorption of the thread will stimulate the infiltration of inflammatory cells and the proliferation of fibroblasts in thesurrounding tissue and then form scar tissue,which will affect the design and effect of revision rhinoplasty.