自体鼻中隔软骨在唇裂继发鼻畸形矫治术中应用.docVIP

自体鼻中隔软骨在唇裂继发鼻畸形矫治术中应用[摘要]目的:探索自体鼻中隔软骨在唇裂继发鼻畸形中的应用。方法:在行唇裂术后鼻畸形矫治术时应用自体鼻中隔软骨重建鼻软骨支架,改善外观。结果:应用本法共矫治单侧唇裂30例,双侧唇裂12例,无感染及自体软骨外露,矫治畸形效果良好。结论:本法行鼻畸形矫治同时就近取材,无另外增加术区,取部分鼻中隔软骨后保留“L”形支撑结构,不出现鼻梁塌陷现象。应用自体软骨重建鼻软骨支架特别适用于自体鼻翼塌陷、鼻小柱歪斜的唇裂患者。 [关键词]自体鼻中隔软骨;唇裂;鼻畸形 [中图分类号]R765.9[文献标识码]A[文章编号]1008-6455(2010)05-0676-02 The application of autogenous septal cartilage in cleft lip nasal deformity GAO Hui,CHEN Chao,XIE Miao,WU Xiao-hui,LI Yan,KANG Yan-ling,LI Qing-hua (The Center of Plastic Surgery,First People’s Hospital of Shijiazhuang, Shijiazhuang050021,Hebei,China) Abstract:ObjectiveTo evaluation the the application of autogenous septal cartilage in cleft lip nasal deformity.MethodsApply autogenous nasal septal cartilage in cleft lip nasal deformity operation to reconstruct nasal cartilage support and correct nasal shape.Results30 unilateral cleft lip cases and 12 bilateral cleft lip cases were treated with this method didn’t exposed infected autogenous septal cartilage and obtained satisfactory results.ConclusionThis method draw materials convenient,don’t add new operating area, and retain “L”-supporting structure and don’t occur nasal collapse. This operation through the application of autogenous nasal septal cartilage to reconstruct nasal cartilage support is particularly applicable for those patients with alar collapse and wry nasal columella. Key words:autogenous septal cartilage;cleft lip;nasal deformity 在唇裂继发鼻畸形的患者中,其畸形表现通常包括鼻尖低垂、鼻小柱短小偏斜、鼻翼塌陷,甚至鼻背歪斜,术中会发现患侧鼻翼软骨发育不良。单纯悬吊鼻翼软骨至鼻背软骨,上唇瘢痕瓣延长鼻小柱,其远期效果不稳定[1]。自2000年以来,笔者采用了自体鼻中隔软骨做支撑物,重建鼻软骨支架,取得满意效果[2-3]。 1资料和方法 1.1 临床资料:本组患者42例,男性患者32例,女性患者10例,年龄12～24岁,单侧唇裂30例,其中,左侧唇裂16例,右侧唇裂14例,双侧唇裂12例。 1.2 手术方法 1.2.1麻醉及手术切口设计:0.5%利多卡因与1/20万肾上腺素混合溶液行双侧眶下孔神经阻滞麻醉,及局部浸润麻醉。经鼻底蝶形口切开皮肤及皮下组织,紧贴鼻翼软骨及鼻侧软骨表面向上做锐性分离(图1)。 2.2.2 切取鼻中隔软骨:牵拉皮肤暴露鼻锥,分离鼻翼软骨外侧脚。用15号小圆刀自两侧鼻翼软骨内侧脚间纵行切开,显露鼻中隔软骨。用中隔剥离器紧贴中隔软骨面脱套剥离两侧粘骨膜,范围从前鼻嵴到梨骨的整个粘骨膜下,暴露鼻中隔软骨。切取其后下部,保留8～0mm宽的“L”形支架结构(图2)。 2.2.3 鼻支架的重塑:充分松解鼻翼软骨及皮肤的异位粘连,离断挛缩的降鼻肌,将鼻翼软骨穹窿部悬吊于鼻背软骨部。雕刻所取的