鼻部畸形综合矫正修复完全性唇裂术后鼻畸形  

Integrated Epithesis of Nasal Deformity after Ptothesis of Complete Cleft Lip

作　　者：杨亚东[1] 高 扬 张军波[1] 王元元[1] 杨 洋 鲁元刚[1] 

机构地区：[1]第三军医大学大坪医院整形美容科部门

出　　处：《科学咨询》2014年第3期46-49,共4页

摘　　要：目的 探讨鼻部亚单位立体重建在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 回顾研究2006年1月－2011年6月收治79例单侧完全性唇裂修复术后鼻畸形病例。该组病例男35例，女44例；年龄9～53岁。左侧43例，右侧36例。唇裂修复术至二期矫正手术时间为2～52年，平均15年。鼻畸形主要为鼻小柱向健侧偏斜、短缩，鼻中隔歪曲，鼻翼扁平、塌陷，鼻孔宽大、双侧不对称，鼻翼脚错位，口鼻漏。术中根据具体情况，将鼻部分成若干个亚单位并针对具体畸形个性化设计并进行及矫正。结果 术后1例假体排斥，予及时取出，6个月后换用膨体植入成功；一例口鼻漏封闭后再漏，但漏口明显较术前缩小，经二期再封闭痊愈。其余患者切口均Ⅰ期甲级愈合，无术后并发症发生。鼻外形矫正良好，患侧鼻翼基本恢复正常弧度，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10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，进行个性化设计及矫正。各鼻亚单位的立体重建是矫正唇裂术后继发鼻畸形的关键。Objective To discuss the operative method and therapeutic effect of correcting nasal deformity after prothesis of unilateral complete cleft lip with stereo reconstruction of nasal subunit. Methods From January 2006 to June 2010, 79 patients with nasal deformity after prothesis of unilateral complete cleft lip were treated. There were 35 males and 44 females aged 9-53 years old. The deformity located on the left side in 43 cases and the right side in 36 cases. Time between cleft lip prothesis and secondary epithesis was 2-52 years （average 15 years）. The major manifestations of the deformity were deviation and crispation towards normal side of nasal columella, distortion of nasal septum, applanation and collapse of nasal ala, lenity and asymmetry of nostrils, malposition of nasal alar basement. During epithesis, with nose divided into several subunits, the individual-orientated epithesis design and correction were performed based on specific deformity. Results after surgery, 1 case suffered postoperative rejection, the prosthesis was dislodged promptly, and reimplant of expanded polytetrafluoroethylene （ePTFE） was performed 6 months later without postoperative rejection. In 1 case leakage appeared after the closure, but rhinorrhea was evidently reduced and cured after second closure. The incision of the remaining patients all healed in grade A without any postoperative complications. The effect of epithesis was good with such manifestations as the normal radian of injured nasal ala and symmetrical nostils. All patients were followed up for 3 months-2 years （average 10 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, the individual-orientated epithesis design and correction were performed. The stereo reconstruction of the nasal subunit was the key to correct secondary nasal deformity after prothesis of cleft lip.

关 键 词：唇裂 鼻畸形 鼻部亚单位 矫正 

分 类 号：S858.28[农业科学—临床兽医学]