同期鼻中隔和鼻整形术

目的：探讨同期鼻中隔和鼻整形术治疗伴有鼻中隔偏曲的歪鼻、驼峰鼻、鹰嘴鼻等外鼻畸形的手术方法和效果。方法：采用鼻侧软骨与大翼软骨间切口，单面一边骨膜蒂骨瓣截骨法处理骨锥畸形，联合“转门法”矫正鼻中隔偏曲。结果：36例均获满意效果，随访32例受术者1～15年，无复发和并发症。结论：本手术方法既避免了鼻骨及鼻中隔软骨的游离移位和鼻黏膜损伤，又保证了鼻骨和鼻中隔软骨的血供，在矫正了外鼻畸形的同时，又矫正了偏曲的鼻中隔，收到外鼻美容与恢复鼻腔通气功能的双重功效。     

Bone Chips and Diced Cartilage: An Anatomically Adopted Graft for the Nasal Dorsum

Since 1996, cranial bone chips or septal bone chips harvested during septal deviation surgery and small chips of ear or septal cartilage have been used in 67 patients for dorsal nasal augmentation or for smoothing dorsal nasal irregularities. In this study, 59 overresections of ostecartilaginous nose structures during previous aesthetic nose surgeries and 8 primary rhinoplasties occasioned the use of bone or cartilage grafts. For 57 patients both bone and ear cartilage grafts were used for the reconstruction. Bone grafts were used for seven cases and cartilage grafts for three cases.The results from 7 years, of experience with this method of nasal dorsum reconstruction were satisfactory and durable. The most important advantage of this method is that the bony side of the nose is reconstructed with bone and the cartilage side with cartilage. Another advantage is that the bone chips are incorporated with both nasal bones, building a strong dorsal nasal bony monoblack.This technique also is useful for augmenting mild saddle nose deformity and dorsal nasal projection deficiency on the bony part, cartilage part, or both parts.Presented at 16th Congress of ISAPS, Istanbul, Turkey, 26–29 May 2002 and 24th National Meeting of the Turkish Plastic Reconstructive Aesthetic Surgery Society, Ankara, Turkey, 18–20 October 2002.     

Structure rhinoplasty of the long nose

Rhinoplasty modifies the aesthetic appearance and functional properties of the nose with operative manipulation of the skin, underlying cartilage, bone, and linings. A long nose is an aesthetically undesired feature disturbing the harmony of the face. The underlying pathology of the long nose may be due to either a long septum that invades the lip or dislocation of the alar cartilages downward from the aponeurotic attachments to the septal angle. The increase in the nasal height due to a dorsal nasal hump may give an illusion of a long nose. An absent or shallow frontonasal angle also gives the illusion of a long nose. With the introduction of the dynamics of the nasal structures and dynamics in rhinoplasty, recreation of a straight nasal dorsum and a normal frontonasal angle dynamically shortens the long nose. This study presents a multicenter experience (three centers) in rhinoplasty of long noses. The study included 138 patients who complained of having a long nose. The study employed the concept of structure rhinoplasty to address the three-dimensional nasal structures contributing directly or indirectly to the appearance of the long nose rather than the traditional excisional techniques. Based on objective and subjective evaluation, shortening of the nose was achieved in 122 patients (88.4%) with better overall nasal aesthetics. The study concluded that structure rhinoplasty, which addresses the three-dimensional nasal anatomy, maximizes the aesthetic and functional outcomes when treating the long-nose deformity.     

Reconstructive surgery of the leprosy nose: a new approach.

There has still been no reduction in the detection rate worldwide for leprosy, despite supervised multi-drug therapy. In time, leprosy can result in a severe saddle-nose deformity leading to functional problems, disfiguration and stigmatization. In severe cases, only the nasal skin tissue and the lower lateral cartilages are preserved. In such cases, the ideal would be to restore the cartilaginous skeleton but, by contrast with other causes of saddle-nose deformities, this is complicated by the quantity and the poor quality of the remaining nasal mucosa. Leprosy-related saddle-nose deformities are therefore challenging and difficult to reconstruct with the techniques that have been proposed in the past. In this study, 24 patients underwent rhinoplastic surgery involving the use of autogenous costal and/or auricular cartilage or composite grafts. The nasal septum, the upper laterals and the anterior nasal spine were reconstructed with a dorsal onlay attached to a columellar strut with an extension on the proximal side. Before surgery, the saddle-nose deformities were classified according to severity with a new system based on clinical symptoms and signs. Postoperative evaluation was performed at least two years after surgery (N=17). Functional and aesthetic improvement, resorption rate, warping, infection and extrusion were analysed. Functional and aesthetic improvements were achieved in 15/17 patients. None of the patients developed an infection and extrusion or warping of the implants was not observed. The resorption rate depended on the localization and the type of cartilage implant. In general, auricular conchal cartilage implant grafts resulted in less resorption than costal cartilage. Least resorption (4/17 patients) was observed in the dorsal onlay grafts of both conchal (1/6) and costal cartilage grafts (3/11). Resorption of columellar strut implants and shield grafts was observed in 7/17 patients. No resorption was seen of composite grafts (0/4) and alar battens (0/7). Autogenous cartilage implants can be used to reconstruct saddle-nose deformities in leprosy with a minimum risk of complications. The preoperative grade of severity was used as a basis for the development of guidelines for optimal long-term functional and aesthetic outcome.     

Alar Batten Cartilage Graft: Treatment of Internal and External Nasal Valve Collapse

Background  The aim of this study was to describe the efficacy of alar batten graft in correcting internal and external nasal valve collapse (i.n.v. and e.n.v.) and evaluate the functional and aesthetic results. Methods  From July 2006 to September 2008, 80 patients (54 females and 26 males) underwent alar batten cartilage grafting. The patients were divided into three groups: (1) 55 patients with iatrogenic nasal valve collapse (80% i.n.v., 20% e.n.v.), (2) 15 patients with posttraumatic nasal valve collapse (45% i.n.v., 55% e.n.v.), and (3) 10 patients with congenital nasal valve collapse (100% e.n.v.). Patients were evaluated at 6, 12, 24, and some at 36 months after surgery. The final follow-up was at least 24 months. Results  The results of this study revealed a significant increase in the size of the aperture at the internal or external nasal valve after the application of alar batten grafts. All the patients noted improvement in their nasal airway breathing and in their cosmetic appearance. No major complication was observed. Conclusion  The alar batten graft is a simple, versatile technique for long-term reshaping, repositioning, and reconstruction of the nasal valve collapse.     

Modified Alar Swing Procedure in Saddle Nose Correction

Reconstruction of the saddle nose may involve the use of different augmentation materials, from autogenous bone and cartilage to alloplastic materials. The most important problems when considering the choice of reconstructive technique, besides underlying pathology and expected result, include: long-term stability, donor morbidity, tendency of the implant to infection, extrusion, and resorption. The use of the lateral crura of the lower lateral cartilages as dorsal onlay was reserved for the corrections of minor supratip depressions (flying wing and alar swing procedure). The authors suggest the use of pedicled flaps of cephalic portions of lateral crura as dorsal septal strut, which may increase the profile line more than dorsal onlay. Reconstruction is performed using open rhinoplasty approach. Pedicled flaps of the cephalic portions of lateral crura are transfixed in the sagittal plane and, following separation of upper lateral cartilages and medial crura, placed on the dorsum of nasal septum. Upper laterals are sutured to newly formed cartilaginous dorsum, or a new bridge is created using conchal cartilage. Columellar strut may be formed of the septal cartilage. Authors have performed such corrections in 15 patients with good long-term functional and aesthetic results.     

鼻中隔偏曲畸形矫正同期鼻整形术

目的:探讨鼻中隔偏曲畸形矫正同期鼻畸形娇正的手术方法和效果.方法:采用鼻侧软骨和大翼软骨间切口,显露畸形的中隔软骨及鼻骨结构,松解牵拉力量,矫正鼻中隔畸形,截骨及复位鼻骨,使其解剖复位,重塑鼻支架.结果:本组39例,均获满意效果,无复发和并发症.结论:本手术方法矫正偏曲畸形的鼻中隔的同时,矫正外鼻的畸形,消除了引起畸形的原因,重塑外鼻支架,收到了恢复鼻腔通气功能与外鼻美容的双重效果.     

婴儿期唇裂鼻畸形早期修复的临床研究

目的:探讨在婴儿期早期修复唇裂,同期矫正鼻畸形的可行性。方法:采用Millard唇裂修复法修复唇裂,同期矫正鼻畸形,使移位的鼻翼软骨、鼻中隔软骨复位,以恢复正常的解剖关系。结果:30例患儿唇裂鼻畸形早期矫治,经6～8年随访,取得满意效果。结论:早期修复唇裂,同期矫正鼻畸形,使畸形的鼻翼软骨、鼻中隔恢复到正常的解剖位置并在此位置上生长发育,鼻畸形可明显改善。     

鼻内镜下复合鼻外伤的整形美容修复

目的探讨鼻内镜下复合鼻外伤整形美容I期修复的方法与疗效。方法选取54例外伤在1个月之内，结合体征及鼻骨CT扫描，确诊为复合鼻外伤的患者。通过鼻骨三维重建CT扫描及术中所见，分析外伤部位。然后于鼻内镜下采取综合方法，治疗鼻中隔偏曲，手术中尽量保留骨与软骨，以维护鼻中隔的支架结构，治疗鼻中隔偏曲。鼻内镜下经鼻中隔黏膜囊入路行鼻骨复位术，在鼻骨骨折的底表面明视下将骨折复位。结果外鼻支架双侧骨折占92．59％（50／54），鼻中隔软骨损伤占92．59％（50／54），筛骨垂直板骨折占70．37％（38154），犁骨偏曲骨折占22．22％（12／54）。鼻内镜下鼻中隔整形术方式有：软骨推移42．59％（23／54），“井”字划痕24．07％（13／54），条状切除38．89％（21／54），骨折移位61．11％（33／54），骨部分切除31．48％（17／54）。54例中，显效90．74％（49／54），好转9．26％（5／54）。结论鼻内镜下鼻中隔偏曲整形术联合经鼻中隔剥离黏膜囊入路鼻骨复位整形美容术，疗效好，能同时解决外形与功能的问题。     

基于鼻部美学亚单位鼻翼缺损修复术式的选择

目的参照鼻部美学亚单位的原则,根据鼻翼缺损的大小和毗邻亚单位的缺损,选择鼻翼缺损的修复术式。方法自2011年7月至2013年6月,我们共收治6例鼻翼缺损的患者。其中鼻翼亚单位缺损4例,行耳郭复合组织游离移植;鼻翼合并鼻尖亚单位缺损2例,应用显微外科技术,行逆行颞浅血管供血的耳前皮瓣游离移植,血管蒂与受区邻近的鼻唇沟处角动、静脉吻合。结果本组6例游离组织均成活,随访6～12个月,重建的鼻翼皮肤色泽与周边接近,弹性正常,瘢痕隐蔽。结论大于鼻翼亚单位50％的缺损,用耳郭复合组织游离移植修复;鼻翼合并鼻尖亚单位的缺损,用吻合血管的逆行游离耳前皮瓣修复。     

Labiocolumellar Graft Combined with Tip Graft in the Management of Inadequate Tip Projection

The short distance of the nasal tip from the alar crease indicates inadequate projection. Tip grafts are commonly used for the management of this problem. In addition to tip grafts, labiocolumellar augmentation by cartilage grafts also provides further elevation of the tip complex for patients with poor tip definition, excessive alar base width, inadequate tip projection, or plunging nasal tip. In addition to standard rhinoplasty procedure and tip grafting for nasal tip augmentation, a linear cartilage graft was inserted centrally just behind the labiocolumellar angle for further tip elevation. The graft was placed in the subdermal plane just anterior to the orbicularis oris muscle to prevent graft displacement and clicking during muscle motion. This procedure was performed for 45 rhinoplasty patients, only three of whom underwent tip plasty procedures alone. During 1 year, 43 patients were followed up. Most of the patients (75%) were satisfied with the results of the procedure. Tip graft combined with labiocolumellar graft is an effective technique for obtaining satisfactory tip projection and correcting the acute labiocolumellar angle. Presented at The XVI. Congress of ISAPS, 26–29 May 2002, Istanbul, Turkey, and should be attributed to Department of Plastic and Reconstructive Surgery, Cerrahpasa School of Medicine, Istanbul University, and Haseki Hospital, Department of Otolaryngology Istanbul, Turkey.     

自体组织或组织代用品植入法纠正唇裂鼻翼畸形

目的：采用自体组织或组织代用品植入和可靠固定法纠正单侧唇裂因患侧梨状孔区上颌骨发育不良和鼻翼软骨移位塌陷而造成的鼻翼畸形。方法：自1996年以来采用自体肋骨、肋软骨、颅骨外板、硅橡胶或膨体聚四氟乙烯等材料植入患侧梨状孔下外侧、鼻翼基底区及鼻翼外侧软骨区，抬高患侧鼻翼基底、纠正塌陷之鼻翼软骨，以微型钛钉／板和缝合固定的方法纠正单侧唇裂鼻翼畸形26例。结果：术后创口愈合良好，无并发症发生。随访19例，3－18个月，表明植入物固定良好、无移位和明显吸收、排斥反应，效果良好。结论：组织植入法矫正单侧唇裂鼻翼畸形手术效果确切，以坚强内固定技术和缝合方法可减少植入物的移位、活动，有助于手术的成功。     

隆鼻术中鼻尖整复的体会

目的：为使鼻尖低平或鼻小柱下垂者在隆鼻术中达到更好的效果。方法：对65例患者在隆鼻术的同时利用自体的鼻翼软骨进行界尖抬高,通过切除部分中隔软骨进鼻算小柱下垂的繁复。结果：经随访一周至半年,效果满意。结论：本文所述方法简单易行,并发症少,患者容易接受,术后外形自然。     

New Technique for Correction of the Microform Cleft Lip Using Trans/Intraoral Approach

The traditional method of treating microform cleft lip with nose deformity uses upper lip external incision, finally leading to a small scar on the upper lip. Hereafter, we present a new method for the correction of microform cleft lip using trans/intraoral approach. The new surgical technique is characterized as (1) using trans/intraoral approach and no incisions on the skin of the upper lip, (2) reconstruction of the “cross” muscular structure using the abnormal muscular insertions at the base of nasal columella and the nasal alar to restore nose deformity, and (3) repair of the lip deformity using two small Z-plasties to get the aesthetic and functional outcome. Thirty patients with microform cleft lip were repaired with our technique, and good functional and aesthetic results of repaired noses and upper lips were obtained in most cases.     

A comprehensive repair of unilateral cleft lip in adults

A comprehensive operation for primary repair of adult cleft lip is described. The technique employs pyriform fossa bone graft, submucosal resection of the nasal septum and alar cartilage onlay graft in addition to a modified rotation advancement with refinements. Good results were obtained in 70% of the cases with no increase in morbidity.     

Correction of Major Saddle Nose Deformities with Nasomaxillary Depression Using an Intraoral and External Open Rhinoplasty Approach

Nasomaxillary depression, which may be seen with major saddle nose deformities, especially as a sequel to childhood nasal trauma, generally is overlooked during management of the saddle nose. To handle both the saddle nose deformity and nasomaxillary depression, the authors used a one-stage intraoral and external open rhinoplasty approach for 12 patients. Lateral nasal osteotomies and correction of midface retrusion with crescent-shaped autogenous rib cartilage grafts were performed through two bilateral intraoral gingivobuccal incisions. The external open rhinoplasty approach was used for the correction of the saddle nose deformities. The mean follow-up period after the surgery was 2 years (range, 1–3.5 years). The correction of nasal tip depression resulting from midface retrusion was evaluated by lateral cephalometric radiographs. The mean movement of the nasal tip anteriorly in the sagittal plane 1 year after the operation was 5.5 mm (range, 4–7 mm). The functional and aesthetic results were satisfactory for all the patients. As the findings show, the intraoral part of the approach provides a route for the placement of cartilage grafts to correct the depressed nasal tip, augment the paranasal area, and provide support to the lateral alar bases and the controlled low-to-low lateral osteotomies. The external part of the approach provides correction of the saddle nose deformity.     

Overresection of the Lower Lateral Cartilages: A Common Conceptual Mistake with Functional and Aesthetic Consequences

Background  Overresection of the lower lateral cartilages to narrow the tip in individuals with thick skin is a common mistake with functional and aesthetic consequences. The most frequent deformities are external valve dysfunction, alar retraction, alar pinch, tip asymmetry, lack of tip definition, and parrot beak deformity resulting from drooping of the tip. Methods  In 82 patients who underwent revision surgery from 1998 to 2007 the lower lateral cartilages were missing. To restore function of the external nasal valve and correct aesthetic deformities it is essential to rebuild the anatomical structure. Tip deformities were analyzed pre- and postoperatively based on clinical evaluation and standardized photographs. Patient satisfaction was evaluated subjectively. Results  Improvement of the poorly defined tip, the underprojected tip, the overrotated tip, and alar pinch was accomplished in all patients (100%). The function of the external nasal valve was restored in all patients (100%). The postoperative results showed a clear improvement in tip asymmetry (95.0%), tip deviation (76.5%), alar retraction (87.0%), and tip ptosis (85.7%). The average follow-up period was 13.8 months. Forty-eight patients (59.8%) rated the result as “excellent,” 27 (32.9%) as “very good,” 5 (6.1%) as “good,” 1 as “not satisfied” (1.2%). Conclusion  Overresection of the lower lateral cartilages to narrow the tip in individuals with thick skin is frequently followed by dysfunction of the external nasal valve and aesthetic deformities. We completely rebuild the structure of the nasal tip. Only an anatomically correct configuration correlates with ideal aesthetics and physiologic function.     

鼻内镜下鼻整形术同期鼻中隔偏曲畸形矫正

目的探讨鼻内镜下同期矫治鼻畸形及鼻中隔偏曲的手术方法与效果。方法鼻内镜下采用Killian切口和与其相连的大翼软骨间切口,显露畸形鼻骨结构及鼻中隔偏曲部位,松解牵拉力量,鼻中隔成形术消除鼻中隔畸形,截骨及复位鼻骨,使其解剖复位,重塑鼻支架。结果本组27例,均获满意效果,无复发和并发症。结论本方法可同时矫正鼻中隔及外鼻畸形,消除致畸原因,重塑外鼻支架,达到了恢复鼻腔通气功能与外鼻美容的双重效果。     

成人单侧唇裂继发鼻畸形的整复

目的 为单侧唇裂术后常见的继发鼻畸形改善外形,解除其心理负担,方法 纠正鼻小柱和鼻中隔的偏斜,游离塌陷的鼻翼软骨并悬吊在对称位置,用Millard术式C瓣,鼻槛组织瓣或上唇瘢痕组织瓣延长患侧鼻小柱,必要时用假体或自体组织抬高鼻背,鼻尖和丰满鼻底,1999-2000年,共修复成人单侧唇裂继发鼻畸形50例。结果 所治疗50例术后随访1-12个月效果均较满意。结论 纠正鼻小柱,鼻中隔歪斜,延长患侧鼻小柱软组织极为重要。广泛游离患侧鼻翼软骨并复位到正常位置固定,才能获得一个对称的鼻尖,如视需要,作鼻背鼻尖部和鼻底的充填,则效果更佳。     

Aesthetic considerations of the cleft lip operation

The results of a cleft lip operation are checked from the anterior, the profile, and the caudal views and even if the deformities are minimal, for aesthetic reasons they should be repaired. Philtrum length, philtrum shape, philtrum depth, nasolabial triangular area, vermilion thickness, Cupid's bow peak, horizontal upper lip groove, vermilion border, alar size, depth of alar groove, nasal deviation, nostril shape, nasal tip, columella height, sill shape, columella width, and facial balance of the anterior, profile, and caudal views are used as aesthetic checkpoints for the results of a cleft lip operation. If deformities are found, the aesthetic plastic surgeon should repair them to achieve a more satisfactory result. In addition, augmentation rhinoplasty, augmentation mentoplasty, or other craniofacial surgery may be performed.Presented at the VIII Congress of International Society of Aesthetic Plastic Surgery, Madrid, Spain, September 15–18, 1985