The Influence of Columella Retraction Suture on the Measurement of the Nose

鼻小柱內縮性縫合對於鼻型的影響

李秉勳(Ping-Hsun Lee) ； 顏琤嬑(Cheng-I Yen) ； 蕭彥彰(Yen-Chang Hsiao)

《臺灣整形外科醫學會雜誌》 29卷4期 (2020/12) Pp. 257-266

摘要

Background: Post rhinoplasty edema has always been a major cause of immediate post-operation satisfaction decline. It usually leads to blunting of columellar labial angle and excessive nostril show. Columellar retraction suture may obliterate the dead space in the columella-tip and nasolabial complex after rhinoplasty which possess the potential of correcting the problems mentioned above and regain customer satisfaction. Aim and Objectives: To evaluate the influence of the columella retraction suture. Materials and Methods: During the period from 2018/01/01 to 2018/08/31, at Chang-Gung memorial hospital, fifty-four patients received columella retraction suture. A standardized series of pictures were taken with the usage of Image J® for outcomes measurement and evaluation. The changing in the proportion of pixels counts of bilateral nostril to tip-columella-ala subunits and the changing of the columellar labial angle were measured at three different timings (T0: pre-columella retraction suture, T1: immediate post columella retraction suture and T2: three-month post columella retraction suture). Every measurement was performed 5 times by the same operator and the extreme values at both ends were excluded. The remaining values were averaged and used as the final measurement data. Results: Among the 54 patients, five of them were excluded due to missing data or unclear operation records. Other ten patients were excluded because of blurring or missing photographs. The remain 39 patients includes 8 males and 31 females. The average age of the patients was 36.90 ± 12.32 year-old. The average columellar labial angles were 110.33, 97.82 and 100.75 degrees for T0, T1 and T2 separately. As for the bilateral nose show, the proportion of pixels counts of bilateral nostril show to tip-columella-ala subunits were 0.120, 0.067 and 0.072 for T0, T1 and T2 separately. For the effects evaluation, paired t test was calculated and both columella labial angle and the pixels counts of bilateral nostril show to tip-columella-ala complex showed significant difference among T0 vs. T1 and T0 vs. T2. No statistical difference was found among T1 vs. T2. Conclusion: Columella retraction suture do show the potential of reducing the nostril show and avoiding a blunting columellar labial angle in advance after open-tip rhinoplasty.

關鍵字

rhinoplasty ； columella retraction suture ； nostril show ； columellar-labial angle

並列摘要

背景：術後水腫常是開放式鼻整形手術病患感到不滿意的原因，它會造成鼻唇角鈍化與鼻孔外翻。鼻小柱內縮性縫合理論上可減少術後死腔的空間進而降低水腫，提早改善上述之問題。惟目前仍沒有相關文獻提出其效果評估。目的及目標：評估並測量使用鼻小柱內縮性縫合之案例的術前及術後照片以確認其對鼻型之影響。材料及方法：本次採回溯性研究方法，自2018/01/01至2018/08/31之間，共39位病患（包含8名男性，31名女性）接受鼻小柱內縮性縫合。將其術前及術後照片測量並分析其成效。結果：鼻小柱唇角均值從縫合前的110.33±7.79度降到了縫合後的97.82±6.73度，並於縫合後三個月維持於100.75±7.27度。鼻孔外露也從縫合前的12.0%±2.5%降到了術後的6.7%±1.4%，並於縫合後三個月維持於7.2%±2.2%。統計學上來說，兩者之縫合前比上縫合後，及縫合前比上縫合後三個月皆有顯著差異。而縫合後比上縫合後三個月則無統計上差異。結論：鼻小柱內縮性縫合能有效提早降低術後水腫問題，並改善鼻唇角鈍化與鼻孔外翻之問題，是個臨床上非常有幫助的手術技術。