다공성 폴리에틸렌 비주지주를 이용한 비주전진술 및 실리콘고무 융비술: 인체계측학적 연구

Abstract

The nasal tip of the Asian is characterized by a bulbous appearance due to thick and tense skin. flaring of nostrils, and a short nasal tip projection due to underdevelopment of alar cartilages and retruded columella. Conventional augmentation rhinoplasty using silicone implant which has been routinely performed at the Asian nose has its limitations. Over the past 2 years, a total 33 patients, aged 19 to 47 years(mean 29 years) underwent open rhinoplasty to correct columellar retraction, to lengthen the nose and to improve the appearance of the nasal tip using columellar strut in conjunction with augmentation with silicone dorsal implant. The columellar strut for control of columellar shape is optimally constructed from 0.85 mm thickness porous polyethylene(Medpor)sheet. The columellar strut is placed between the medical crura and fixed to the caudal septum. With the strut stabilized, each medial crus is advanced to the desired position. The fixation sutures are placed at 3 points: the dormal segment of the middle crus, the junction of the middle and medial crus, and the junction of the columellar segment and the footplate segment of the medial crus of the alar cartilage. Twenty-five surface measurements based on the works of Farkas included 9 singles and 5 paired lengths, and 3 angles indirectly taken from the surface of the nasal stone model. The preoperative measurements were compared with those of the postoperative. The mean follow up period was 17 months(15-24 months). The analysis of the results was conducted using Wilcoxan matched-pairs signed-ranks test. The nose length, the nasal tip protrusion, the alar length, the alar half arc, the columellar length, the nostril length, and the alar rim-columellar length were significantly increased. The intercanthal distance, the nose width, the nostril width, and the upper lip length were significantly decreased. The nasolabial angle was also significantly increased. Good to excellent asethetic results were noted in all patient, although one patient did experience mild deviation of a columella. No extrusions occurred. Using the control columellar polyethlene strut, the retracted columella was advanced, the tip was projected, the nose was lengthened, and the nostril were narrowed and elongated. This technique is valuable in the rhinoplasty patient was has retracted columellar, short nose and long upper lip.

저자들은 융비술과 다공성 폴리에틸렌판을 비주지주로 이용한 비주전진술을 동시에 시행하였다. 양쪽 비약연골을 재배치하여 비ㅜ지주에 고정하면 비익연골과 비주지주는 하나의 복합체로서 작용하므로 비첨을 전방돌출시킬 수 있었을 뿐만 아니라 비주도 미측전위시킬 수 있었다. 수술결과를 모형석고와 두개골계측 X선사진을 통한 간접적 생체계측분석 했을 때 다음과 같은 결론을 얻을 수 있었다. 가. 비순각이 14.5도나 증가되어 술후 96.5도가 됨으로써 젊은 한국여성의 평균치인 93.6도보다 더 크고, 한국성인이 가장 이상적으로 생각하는 95.0-100.0도의 범위 안에 들었다. 나. 비주를 비익연보다 2.65mm 미측전위시킬 수 있었다. 다. 상순 길이가 16% 감소되는 이차적인 효과를 얻을 수 있었다. 라. 비소엽길이가 오히려 감소함으로써 비소엽길이-비첨돌출비지수가 1대 2.4가 되어 정상에 접근하였다.