老年鼻鼻整形术中的结构与功能考量

文献信息

中文摘要

探讨人类鼻部随年龄相关的解剖、结构和功能变化，并评估用于老年患者结构年轻化和气道重建的最有效手术技术。利用包括PubMed/Medline、Scopus、Web of Science和Embase在内的成熟科学数据库，对截至2024年发表的文献进行了全面的叙述性文献综述。采用结构化检索策略，使用“老年鼻”、“鼻整形术”、“鼻尖下垂”、“鼻瓣膜塌陷”和“鼻软骨”等关键词。纳入同行评议的临床试验、解剖学评估和权威手术指南，以综合关于年龄相关形态学变化以及结构手术技术在老年患者中疗效的当前证据。衰老过程从根本上改变鼻部形态，主要导致鼻尖下垂、鼻背假性驼峰形成和鼻瓣膜塌陷。这些变化由皮肤弹性下降、软组织萎缩和软骨悬韧带减弱所驱动。由于标准鼻中隔成形术通常无法解决老年人的气道阻塞，因此需要强有力的结构改造。采用鼻中隔延伸移植物、鼻小柱支撑和舌槽式定位的技术可成功恢复鼻尖旋转和突出度。同时，撑开移植片和鼻翼支撑移植片的应用可有效对抗动态性内、外鼻瓣膜塌陷，从而显著改善鼻气流。老年鼻因进行性组织和软骨退化而呈现出美学与功能相互交织的挑战。手术管理必须超越简单的切除，优先考虑强有力的软骨加强和瓣膜稳定，以在老年患者中实现持久的美容效果和最佳的功能性呼吸。

英文摘要

To investigate the age-related anatomical, structural, and functional changes occurring in the human nose, and to evaluate the most effective surgical techniques utilized for structural rejuvenation and airway restoration in older patients. A comprehensive narrative literature review was conducted utilizing established scientific databases, including PubMed/Medline, Scopus, Web of Science, and Embase, covering articles published up to 2024. A structured search strategy was applied using keywords such as "aging nose," "rhinoplasty," "tip ptosis," "nasal valve collapse," and "nasal cartilages." Peer-reviewed clinical trials, anatomical evaluations, and authoritative surgical guidelines were included to synthesize the current evidence regarding morphological age-related changes and the efficacy of structural surgical techniques in older patients. The aging process fundamentally alters nasal morphology, primarily resulting in tip ptosis, dorsal pseudohump formation, and nasal valve collapse. These changes are driven by diminished skin elasticity, soft-tissue atrophy, and the weakening of cartilaginous suspensory ligaments. Because standard septoplasty often fails to resolve airway obstruction in older adults, robust structural modifications are required. Techniques utilizing septal extension grafts, columellar struts, and tongue-in-groove positioning successfully restore tip rotation and projection. Concurrently, the application of spreader grafts and alar strut grafts effectively counteracts dynamic internal and external nasal valve collapse, thereby significantly improving nasal airflow. The aging nose presents intertwined aesthetic and functional challenges caused by progressive tissue and cartilage degradation. Surgical management must move beyond simple resection and prioritize strong cartilaginous reinforcement and valve stabilization to achieve durable cosmetic outcomes and optimal functional breathing in older patients.