鼻腔内外整体评估在鼻内镜下功能性鼻整形术中的临床应用

Clinical application of holistic assessment for individualized endoscopic functional rhinoplasty

目的结合鼻腔内外整体评估,探讨鼻内镜下功能性鼻整形术的诊治策略。方法采用前瞻性研究方法,招募2018年2月至2021年8月在重庆医科大学附属第一医院耳鼻咽喉科接受鼻内镜下功能性鼻整形术的患者。于术前进行鼻腔内外结构及功能的整体评估,制定个体化手术策略。根据手术策略,施行鼻中隔矫正术、下鼻甲消融术、下鼻甲骨折外移术、下鼻甲骨黏膜下切除术、背侧扩展软骨移植物、歪鼻矫正、假体或自体软骨植入、驼峰截除+截骨等,从鼻功能和美容2方面进行调整。术前和术后6个月,应用内鼻阀(INV)角度、INV塌陷分级、INV横截面积、外鼻阀效力(ENVE)指数评估鼻阀区结构,应用鼻阻塞症状评估(NOSE)量表、鼻阻力[包括鼻腔总阻力(RT)、鼻腔阻力差异比(R 1r)]评估鼻通气功能,应用面部形态自我测评量表-鼻整形版(FACE-Q RM)、鼻整形结果评估(ROE)量表、外鼻亚单位测量评估鼻外形整形效果,应用抑郁自评量表(SDS)、焦虑自评量表(SAS)评估心理状态,最后行患者满意度与各主客观指标的相关性分析。手术前后数据比较采用配对t检验;相关性检验采用Pearson分析法。结果共招募50例患者,男18例,女32例,年龄23~52岁,平均35.7岁。所有患者均有鼻塞症状,其中伴歪鼻畸形28例,鼻阀区狭窄12例,鞍鼻畸形6例,驼峰鼻4例。与术前相比,患者术后INV角度明显增大、INV塌陷分级降低、INV横截面积增大、ENVE指数增大(P均<0.05)。术后NOSE量表评分降低,鼻阻力测量示RT、R 1r下降(P均<0.05),提示鼻塞症状明显缓解。术后FACE-Q RM及ROE量表评分升高(P均<0.05),提示患者鼻外形满意度升高;外鼻亚单位测量示术后鼻翼上宽、下鼻翼角有所缩小(P均<0.05),其余结构测量值无明显变化。患者术后SDS、SAS评分均明显低于术前,差异有统计学意义(P均<0.05)。患者术后整体满意度较术前提高(P<0.05)。Pearson相关性分析显示,患者满意度与INV角度、INV横截面积、ENVE指数、鼻外形FACE-Q RM、ROE量表评分呈正相关,与INV塌陷分级、NOSE量表评分、鼻阻力测量值呈负相关,与外鼻亚单位测量值无相关性。结论结合鼻部结构、鼻通气功能及外鼻美学等进行鼻腔内外整体评估,有利于制定个体化功能性鼻整形术的诊治策略,从而提高患者的满意度。

ObjectiveTo investigate the diagnosis and strategy of individualized functional rhinoplasty based on the overall evaluation of the nasal cavity as a integration.MethodsA prospective study was carried out in the patients who underwent endoscopic functional rhinoplasty at the Department of Otorhinolaryngology,the First Affiliated Hospital of Chongqing Medical University from February 2018 to August 2021.The overall evaluation of the internal and external structure and function of the nasal cavity was performed before surgery,and the individualized surgical strategies were developed.According to the surgical strategy,nasal septum correction,inferior turbinate ablation,inferior turbinate fracture displacement,inferior turbinate submucous resection,dorsal extended cartilage graft,crooked nose correction,prosthesis or autologous cartilage implantation,hump reduction and osteotomy were performed to adjust the nasal function and aesthetics.Internal nasal valve(INV)angle,INV collapse grade,INV cross-sectional area,and external nasal valve effectiveness(ENVE)index were used to evaluate the structure of nasal valve area.Nasal obstruction symptom assessment(NOSE)scale and nasal resistance[including total nasal resistance(RT),nasal resistance differential ratio(R 1r)]was used to evaluate nasal ventilation function.Facial clinimetric evaluation questionnaire rhinoplasty module(FACE-Q RM),rhinoplasty outcome evaluation(ROE)scale,external nasal subunit measurement was used to evaluate nasal appearance,and self-rating depression scale(SDS)and self-rating anxiety scale(SAS)was used to evaluate psychological status.Finally,the correlation between patient satisfaction and subjective and objective parameters were analyzed.The data before and after operation were compared by paired t-test.Correlation was tested by Pearson analysis.ResultsA total of 50 patients were included,including 18 males and 32 females,ranging in age from 23 to 52 years,mean age 35.7 years.All patients had symptoms of nasal congestion,of which 28 cases with crooked nose deformity,12 cases with nasal valve stenosis,6 cases with saddle nose deformity,and 4 cases with hump nose.Compared with preoperative,postoperative INV angle was significantly increased,INV collapse grade was decreased,INV cross-sectional area was increased,ENVE index was increased(P<0.05).After operation,the NOSE score decreased,and nasal resistance showed that RT and R 1r decreased,indicating that nasal congestion symptoms were relieved significantly(P<0.05).The postoperative FACE-Q RM and ROE scores increased,indicating that patients’nasal appearance satisfaction increased(P<0.05),external nasal subunit measurement showed that the upper nasal alar width and lower nasal alar angle were reduced(P<0.05),the measured value of residual structure has no significant change.Postoperative SDS and SAS scores were significantly lower than preoperative ones,and the difference was statistically significant(P<0.05).Overall satisfaction was improved(P<0.05).Pearson correlation analysis showed that patient satisfaction was positively correlated with INV angle,INV cross-sectional area,ENVE index,and subjective nasal shape score(FACE-Q RM,ROE),and negatively correlated with INV collapse grade,NOSE score,and nasal resistance measurement,but had no correlation with external nasal subunit measurement.ConclusionCombined with the overall evaluation of nasal structure,nasal ventilation function and external nasal aesthetics,it is beneficial to develop the diagnosis and treatment strategy of individualized functional rhinoplasty,so as to improve patient satisfaction.