单侧唇裂术后继发严重鼻畸形六步序列修复法  

Six-Step Sequential Operation Repair for Serious Nasal Deformity in Unilateral Secondary Cleft Lip Deformitycorrection

作　　者：李希军 LI Xi-jun(Guangzhou Tianhe Haixia clinic,Guangzhou 510000,Guangdong,China)

机构地区：[1]广州天河海峡医疗门诊部,广东广州510000

出　　处：《中国美容医学》2018年第3期121-124,共4页Chinese Journal of Aesthetic Medicine

摘　　要：目的:探讨单侧唇裂术后继发严重鼻畸形的序列手术矫治方法。方法:对23例单侧唇裂术后继发严重鼻畸形的患者采用六步序列修复法:(1)患侧鼻翼基底肋软骨移植,恢复双侧鼻翼基底对称高度;(2)重建鼻嵴矫正鼻中隔偏曲,恢复鼻头中心支撑结构;(3)鼻唇肌复位,重建患侧鼻孔基底及人中,矫正鼻小柱偏斜;(4)患侧鼻翼软骨黏膜瓣V-Y延长,松解黏膜对鼻翼软骨的牵拉;(5)鼻翼软骨支架重建,恢复鼻翼软骨双侧对称性;(6)患侧鼻头软三角皮肤部分切除及健侧鼻翼缩小,进一步恢复鼻孔对称性。结果:术后23例患者随访3~12个月,患侧鼻头、鼻翼、鼻孔基底塌陷矫正,鼻小柱居中,双侧鼻孔接近对称,患者满意。结论:矫正单侧唇裂继发严重鼻畸形要按照由鼻底到鼻尖,先恢复骨性支撑平衡,再调整软组织张力平衡的顺序进行,六步序列修复法可以获得良好的矫治效果。Objective To discuss the sequential operations for serious nasal deformity repair in unilateral secondary cleft lip deformity correction.Methods six-step sequential operationswere tested on 23 patients with serious nasal deformity in unilateral cleft lip deformity operations:①Raise the cleft side alar base with rib cartilage implant to obtain symmetry in height of bilateral alar bases;②Reconstruct nasal spine and reset the curved septal cartilage to restore the middle line support to nasal tip;③Repair the cleft side nasolabial muscle to reconstruct cleft side nostril base and philtrum,and to correct the oblique columella;④Extend the cleft side lower cartilage and mucous by V-Y plasty to release the mucosal traction for alar cartilage;⑤Reconstruct lower cartilage support structure to regain symmetrical nasal tip;⑥Remove part of the cleft side soft triangle skin and reduce the normal side ala to further improve nostril symmetry.Results All the cases were followed up 3-12 months after the operations.The cleftnose,alar and the nasal opening base collapse were restored.The columella was centered.The shape of cleft side nose tip,ala and nostril were nearly symmetric,and the patients were satisfied with the results.Conclusion The repair of the serious nasal deformity in unilateral secondary cleft lip deformity should be operated sequentially,from nasal base to nasal tip,from bony support balance to soft tissue tension balance.Six-step sequential operation could contribute tosatisfactory nasal shape.

关 键 词：唇裂继发畸形 鼻畸形 鼻嵴 鼻中隔软骨 鼻唇肌 

分 类 号：R782.21[医药卫生—口腔医学]