单侧唇裂相关鼻畸形的治疗进展  

Clinical treatment research on secondary rhinoplasty of unilateral cleft lip nasal deformity

作　　者：赵佳琪 吴镝 Jiaqi Zhao;Di Wu(Cleft Lip and Palate Department of Plastic Surgery,Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing,P.R.China)

机构地区：[1]中国医学科学院整形外科医院唇腭裂整形科

出　　处：《中国口腔医学继续教育杂志》2023年第3期191-196,214,共7页Chinese Journal of Stomatologial Continuing Education

摘　　要：单侧唇裂相关鼻畸形可表现为鼻基底塌陷、鼻尖偏斜、鼻小柱缩短偏移、鼻中隔偏移、鼻翼塌陷、双侧鼻孔不对称等。治疗理念主要注重于结构重建及唇鼻肌肉生物力学重建,以达到鼻部长期对称性及鼻部美学。治疗时机可分为早期唇鼻同期修复、中期鼻整形术及最终鼻整形。目前主流观念认为最终修复手术应在患儿发育成熟期开展,但适时早期修复被认为有利于后期矫正效果。手术方法包括皮瓣转移、肌肉生物力学重建,亦可利用自体软骨、生物材料、人工骨等进行移植物填充及唇鼻部支架重建,重者可采取截骨矫形。目前手术主要针对患者不同鼻畸形特点采取个体化手术方案,常多部位及多方法联合矫正。本文总结了单侧唇裂相关鼻畸形解剖特点、治疗理念、治疗时机以及治疗方式,以期为临床术式选择及改良提供参考及指导。We performed a literature review focusing on advances in the rhinoplasty of unilateral cleft nasal deformity.The nasal deformity of unilateral cleft lip can be manifested as nasal base collapse,tip deviation,columella shortening and deviation,septal deviation,alar collapse,bilateral nostril asymmetry,etc.Timing of rhinoplasty can be divided into primary,intermediate and definitive surgery.It is accepted that the final operation should be carried out in mature stage,while timely and early adjustment is conducive to the later correction effect.Treatment concept mainly focuses on structural remodeling and biomechanical reconstruction of nasolabial muscle tension system,which aims to guarantee long-term nasal symmetry and aesthetics.Detailed treatment contains flap transfer,biomechanical muscle reconstruction,graft material filling(autologous cartilage,biomaterials and artificial bone included)and osteotomy used for severe cases.Present surgical plan is individualized according to the characteristics of nasal deformities,which often combines multiple areas and methods.This article summarizes treatment concepts and therapeutic methods of unilateral cleft nasal deformity aiming to provide useful guidance for the selection and improvement of surgical trails.

关 键 词：唇裂 鼻畸形 唇鼻肌肉张力带 肋软骨移植 鼻中隔成形术 

分 类 号：R78[医药卫生—口腔医学]