【目的】

探讨在鼻综合整形术中自体肋软骨颗粒鼻翼基底填充术对低鼻伴鼻翼基底凹陷患者的治疗效果，分析并评价该治疗方式的有效性及安全性。

【方法】

本研究对中国医学科学院整形外科医院鼻整形与鼻再造中心于2017年6月至2021年6月诊断为“低鼻伴鼻翼基底凹陷”的病例进行回顾性研究，根据术前沟通后患者自主意愿是否接受鼻翼基底填充术进行分组，分为对照组（仅接受自体肋软骨隆鼻术）及观察组（联合自体肋软骨颗粒鼻翼基底填充术）。

疗效评价包括平面图像测量分析和满意度分析。测量分析方面，选取鼻翼基底区相关的解剖标志点，建立鼻翼基底区角度测量体系，对研究对象术前及术后至少6个月的矢状位图像进行标定及测量,对测量数据进行组内和组间对比。满意度评价方面，采用FACE-Q鼻部模块量表（FACE-Q-Rhinoplasty Module）和面部美容模块量表（FACE-Q-Facial Appearance Module）对患者进行术后满意度调查，采用全球美学改善量表（Global Aesthetic Improvement Scale, GAIS）统计独立第三方医生的满意度。

安全性评价方面，采用自行设计问卷和回顾病历方式总结并发症发生率及处理和转归情况。

【结果】

1. 本研究共56例成功随访,对照组27例，观察组29例，两组在人口学数据（性别和年龄组成）及术前角度测量值（鼻小柱-上唇角、鼻基底平面倾斜度）上差异均无统计学意义（均P＞0.05），具有可比性。

2.比较组内术前及术后角度测量数据，两组在鼻小柱-上唇角和鼻基底平面倾斜度上均有显著改善，差异均有统计学意义（均P＜0.01）。

3.比较组间的术后测量数据，两组术后鼻小柱-上唇角测量值的差异无统计学意义（P＞0.05），鼻基底平面倾斜度的差异具有统计学意义，且观察组的术后鼻基底平面倾斜度比对照组高2.5±0.75°（P＜0.01）。

4.在FACE-Q鼻部模块量表评分上,两组评分的差异无统计学意义（P＞0.05）；在FACE-Q面部美容模块量表评分上，观察组比对照组高7.49±3.70，差异具有统计学意义（P＜0.05）。

5.第三方独立医生对面部外观改善度评价方面，观察组总体改善度优于对照组，差异具有统计学意义（P＜0.05）。

6.隆鼻相关并发症主要包括鼻背形态偏斜、鼻部感染。对照组中无鼻背形态偏斜和鼻部感染；观察组中，鼻背形态偏斜发生率为3.4%，无鼻部感染。两组发生率均无统计学差异（均P＞0.05）。

7.鼻翼基底填充术相关并发症包括双侧鼻翼基底欠对称、面部或口内异物感，观察组中发生率分别为6.9%及34.5%，无鼻翼基底填充物感染案例。上述并发症经保守处理后均满意，未行二次修复手术。

【结论】

本项研究表明，在隆鼻术中联合自体肋软骨颗粒鼻翼基底填充术，可较确切地对上颌骨前壁进行增量填充，有效改善鼻翼基底凹陷，提高患者术后面部满意度，具有可靠的安全性和疗效性。

【Objective】

The study aimed to evaluate the efficacy and safety of paranasal augmentation using diced costal cartilage in rhinoplasty for low nose with alar bases concavity.

【Methods】

we retrospectively analyzed the cases diagnosed as low nose with alar bases concavity who underwent rhinoplasty using autologous costal cartilage at the Rhinoplasty and Nasal Reconstruction Center, Chinese Academy of Medical Sciences, from June 2017 to June 2021. The patients were divided into a control group (received only autologous costal cartilage augmentation rhinoplasty) and an observation group (combined with paranasal augmentation using diced costal cartilage), according to patients’ preoperative willingness. The efficacy evaluation included planimetric analysis and satisfaction analysis. In terms of metrical analysis, related anatomical landmarks were selected to establish an angle-measuring system for alar bases. The sagittal images of the cases before and at least 6 months after surgery were calibrated and measured, and the data were compared within and between groups. In terms of satisfaction analysis, FACE-Q-Rhinoplasty Module and FACE-Q-Facial Appearance Module were used to survey postoperative patient-reported satisfaction, Global Aesthetic Improvement Scale (GAIS) was used to survey the satisfaction of a third-party independent surgeon. In terms of safety evaluation, self-designed questionnaires and reviews of medical records were used to summarize the incidence of complications, as well as the corresponding treatments and outcomes.

【Results】

1. A total of 56 patients were followed up in the study, 27 in the control group and 29 in the observation group. There was no statistically significant difference in demographic baseline data (compositions of gender and age) and preoperative metrical values (columella-upper lip angles and inclinations of nasal base plane), which were homogeneous.

2. Comparing the preoperative and postoperative metrical data, both groups showed significant improvements in columella-upper lip angles and inclinations of nasal base plane (all P < 0.01).

3. Comparing the postoperative metrical data between groups, there was no significant difference in the postoperative columella-upper lip angle values (P>0.05). The difference in the values of inclination of nasal base plane was statistically significant, which in the observation group was 2.5±0.75°higher than that in the control group (P<0.01).

4. In the aspect of patient-reported satisfaction, the difference in FACE-Q-Rhinoplasty Module between the two groups was not statistically significant(P>0.05), while the observation group scored 7.49±3.70 higher than the control group in FACE-Q-Facial Appearance Module, and the difference was statistically significant(P＜0.05).

5. Evaluation of facial appearance improvement by a third-party independent surgeon showed the overall improvement was better in the observation group than in the control group (P＜0.05).

6. Augmentation rhinoplasty-related complications included dorsal morphological deviation and nasal infection. There was no dorsal morphological deviation and nasal infection in the control group. In the observation group, the incidence of dorsal morphological deviation was 3.4%, and there was no nasal infection. There was no statistical difference in the above incidences between the two groups (all P>0.05). 

7. Paranasal augmentation-related complications included asymmetry of alar bases and facial or intraoral foreign body sensation. The incidence rates in the observation group were 6.9% and 34.5% respectively. There was no case of filler infection. The above complications were treated after conservative treatments, and no revision surgery was conducted.

【Conclusions】

This study demonstrates that the combination of paranasal augmentation using diced costal cartilage in rhinoplasty, which accurately augments anterior maxilla, is effective in remedying alar bases concavity and improving facial satisfaction, with reliable safety and efficacy.