鼻部亚单位设计综合矫正单侧完全性唇裂修复术后鼻畸形  

EPITHESIS OF NASAL DEFORMITY AFTER PROTHESIS OF UNILATERAL COMPLETE HARELIP WITH DESIGN OF NASAL SUBUNITS

作　　者：黄永新[1] 詹新华[1] 谢洋春[2] 林雪梅[1] 陈建崇[1] 

机构地区：[1]南京军区福州总医院附属第一医院烧伤整形科,福建莆田351100 [2]中国医学科学院整形外科医院

出　　处：《中国修复重建外科杂志》2009年第12期1459-1461,共3页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨采用鼻部亚单位进行设计,矫正单侧完全性唇裂修复术后鼻畸形的手术方法及疗效。方法2006年1月-2008年12月,收治18例单侧完全性唇裂修复术后鼻畸形。男7例,女11例;年龄6～26岁。左侧11例,右侧7例。畸形主要为鼻小柱向健侧偏斜、短缩,鼻翼扁平、塌陷,鼻孔宽大、双侧不对称,鼻翼脚错位。唇裂修复术至二期矫正手术时间为4～21年,平均8年。术中延长鼻小柱,游离塌陷鼻翼软骨并悬吊固定于对称位置,鼻槛组织瓣或鼻底舌形瓣延长患侧上唇,其中11例植入L形硅胶假体隆鼻。结果术后1例植入L形硅胶假体者发生排斥反应,予及时取出,6个月后再行假体植入术后成功。其余患者切口均Ⅰ期愈合,无术后并发症发生。鼻外形矫正良好,患侧鼻翼隆起,恢复正常弧度,双侧鼻孔对称。术后患者均获随访,随访时间3个月～2年,平均8个月。切口隐蔽,未见明显瘢痕,鼻外形维持良好。结论根据鼻部各亚单位畸形特点及形成原因,进行个性化设计鼻翼缘、鼻小柱基底切口并重置固定鼻翼软骨及各组织瓣,使继发鼻畸形患者经矫正后达满意外观。Objective To discuss the operative method and therapeutic effect of correcting nasal deformity after prothesis of unilateral complete harelip with design of nasal subunits. Methods From January 2006 to December 2008,18 patients with nasal deformity after prothesis of unilateral complete harelip were treated. There were 7 males and 11 females aged 6-26 years old. The deformity located on the left side in 11 cases and the right side in 7 cases with major manifestations of deviation and crispation towards normal side of nasal columella,applanation and collapse of nasal ala,lenity and dyssymmetry of nostrils,malposition of basement of nasal ala. Time between harelip prothesis and secondary epithesis was 4-21 years （average 8 years）. During epithesis,nasal columella were extended,collapse nasal alar cartilages were liberated and fixed in symmetrical positions,injured upper lip was extended with nasolabial flap or to ＂tongue-like＂ flap on nasal base. Eleven cases were implanted L-type silicone prothesis to hump nose. Results For 1 case suffered postoperative rejection,the implant of L-type silicone prothesis was taken out promptly,and reimplant of prothesis was performed 6 months later without postoperative rejection. The incision of the other patients all healed by first intention without any postoperative complications. The effect of epithesis was good with such manifestations as the eminence of injured nasal ala,normal radian,and symmetrical nostils. All patients were followed up for 3 months-2 years （average 8 months）. The incision was hidden with well-maintained appearance and no obvious scar. Conclusion Based on feature of nasal subunits and formation causes of deformity,individual-orientated epithesis design of nasal ala margin,nasal columella basement incisions,reset and fix nasal alar cartilages and tissues values can provide the patients suffering the secondary nasal deformity with satisfied appearance.

关 键 词：单侧完全性唇裂 继发鼻畸形 鼻部亚单位 修复 

分 类 号：R782.2[医药卫生—口腔医学] R765.9[医药卫生—临床医学]