自体鼻中隔软骨修复单侧唇裂继发鼻畸形的临床研究

目的 探讨单侧唇裂继发鼻畸形修复术中,用自体鼻中隔软骨重建鼻软骨性支架结构的可行性.方法 2010年1月至2011年10月北京大学口腔医学院·口腔医院口腔颌面外科行鼻整形术的单侧唇裂继发鼻畸形患者41例.术中行横跨鼻小柱切口和双侧软骨下切口,内侧脚间切开,显露切取偏曲的鼻中隔软骨,以之为材料修复重建鼻支架结构,整复鼻外形和鼻中隔偏曲.术前术后摄取正侧位面像和头颅CT检查,评价鼻形态变化和鼻中隔偏曲情况.结果 41例单侧唇裂继发鼻畸形患者通过手术,鼻形态明显改善,术后主观评价手术前后分值平均为2.80;CT扫描显示鼻中隔偏曲程度30例(73％)矫治效果有效,11例(27％)矫治无效,即鼻中隔偏曲程度无改善.结论 以自体鼻中隔软骨为材料重建鼻软骨性支架结构可有效改善单侧唇裂继发鼻畸形,并同期矫治鼻中隔软骨性偏曲.     

自体软骨移植联合鼻唇肌复位术矫治单侧唇裂术后继发鼻畸形

目的探讨自体鼻中隔软骨与耳软骨联合移植同时行鼻唇肌复位术在单侧唇裂术后鼻畸形矫正中的疗效。方法将松解移位的鼻翼软骨悬吊复位至正常解剖位置,切取自体鼻中隔软骨修整成形后植入鼻翼软骨两内侧脚间,耳软骨植入充填患侧鼻翼,同期行鼻唇肌复位术,重建鼻软骨肌肉环,修复鼻部畸形。结果 26例鼻畸形患者术后不同程度改善,随访2～9个月,鼻外形美观,效果满意。结论应用自体鼻中隔及耳软骨移植重建鼻软骨支架同时行鼻唇肌复位术能有效矫正单侧唇裂术后鼻畸形。     

单侧完全性唇裂术后鼻畸形整复术的临床分析

目的：通过对单侧完全性唇裂术后鼻畸形整复方法的研究和改进,探讨其理想的手术方式。方法：以61例单侧完全性唇裂术后鼻畸形患者为研究对象,其中男性36例,女性25例,年龄分布范围3～34岁,平均年龄14.6岁。根据不同的鼻畸形程度进行鼻唇肌肉的解剖复位,鼻翼及鼻中隔软骨悬吊复位固定,以及肋软骨塑形后移植,纠正鼻翼和鼻小柱的畸形。结果：61例单侧完全性唇裂术后鼻畸形患者术后外形均得到明显改善,移植肋软骨未发生明显吸收,患者局部伤愈合良好。结论：单侧完全性唇裂术后患者鼻畸形的手术治疗应注重强调个性化处理。针对鼻畸形的原因,从软组织及鼻翼和鼻中隔软骨等多方面进行矫正治疗,才能获得更为理想的整复效果。     

耳甲软骨在鼻畸形整复术中的应用

目的：探讨应用耳甲软骨移植修复唇裂术后鼻畸形的手术可行性皮临床效果。方法：对10例单侧唇裂鼻畸形患者根据缺损的大小，切取相等的耳甲软骨进行修复。结果：本组10例，手术后随访2年，全部病例鼻畸形矫正效果满意。结论：运用耳甲软骨修复唇裂鼻畸形断裂不全的鼻翼软骨，是一种简便易行的手术方式。     

异体鼻中隔软骨修复唇裂鼻畸形

作者收集鼻中隔偏曲矫治术切除的鼻中隔软骨，保存于弱甲醛等渗液中。在唇裂鼻畸形修复术中，将处理保存的异体鼻中隔软骨植于鼻翼软骨内脚间，增加鼻小柱的支撑力，达到矫正鼻畸形的目的，取得较好的效果。     

单侧唇裂鼻偏曲的分类与治疗

目的 总结单侧唇裂鼻偏曲的分类和相应的外科治疗方法,以提高临床治疗效果.方法 分析2007至2009年在上海交通大学医学院附属第九人民医院口腔医学院唇腭裂治疗中心治疗的单侧唇裂继发鼻畸形176例.根据外鼻锥与面中线的关系,将唇裂鼻偏曲分为3类:骨性鼻偏曲、软骨性鼻偏曲、鼻小叶偏曲,与之对应的手术方法为:骨性鼻锥矫正术、软骨性鼻锥矫正术、鼻小叶矫正术和鼻中隔矫正术.结果 176例患者临床检查无鼻偏曲者93例(53%),伴鼻偏曲畸形者83例(47%).83例鼻偏曲患者中,骨性鼻偏曲8例(10%);软骨性鼻偏曲29例(35%);鼻小叶偏曲46例(55%).以上患者接受相应矫正手术,大部分术后获得满意的效果.结论 单侧唇裂继发鼻畸形患者中近50%可出现鼻偏曲,其中骨性鼻偏曲畸形患者最少,鼻小叶偏曲畸形最多.唇裂鼻偏曲的分类对临床治疗唇裂术后鼻偏曲畸形具有指导意义.     

单侧唇裂术后的鼻有解剖学研究

为探讨组织错位及组织发育不足与单侧唇裂鼻畸形的关系，对３８例伴有鼻畸形的单侧唇裂术后患者在鼻畸形修复术听健患侧鼻翼软骨大小及相对位置进行观察和测量，发现均存在患侧鼻翼软骨错位，若伴有患侧鼻软骨发育不足则鼻畸形更加严重。说明患侧鼻软骨组织错位及发育不足是造成唇裂鼻畸形的局部因素。     

自体肋软骨及Medpor人工骨联合矫治唇腭裂术后继发鼻畸形

目的采用自体肋软骨移植鼻中隔软骨联合Medpor人工骨植入矫治唇腭裂术后继发鼻畸形。方法将切取的自体肋软骨修整成形后植入鼻中隔软骨尾端两侧,以延长鼻中隔,再将松解移位的鼻翼软骨及软组织复位至正常解剖位置,重构外鼻支撑,充分调动和利用皮肤软组织及鼻衬里(黏膜)的活动性和弹性,改善鼻背长度、提升鼻尖高度、延长鼻小柱,联合Medpor人工骨对患侧鼻翼基部植入,一次性完成对复杂鼻畸形的整复。结果矫治3例单侧唇腭裂继发鼻畸形及1例双侧唇腭裂继发鼻畸形的患者,短期随访效果满意。结论本法能有效地改善唇腭裂继发鼻畸形。     

单侧唇裂继发鼻下端畸形张力平衡的重建

目的：探讨单侧唇裂继发鼻下端畸形两侧张力平衡重建的手术方法及临床意义。方法：通过健侧降鼻中隔肌的处理及＂C＂形鼻中隔的纠正,重建鼻小柱两侧的肌张力及软骨弹性张力平衡;将鼻翼软骨外侧脚充分游离,解除鼻翼软骨周边组织的病理影响;用三点缝合二点高位悬吊法重塑外鼻下端软骨支架结构;最后施鼻翼外侧脚软组织的移位。结果：32例患者鼻下端形态恢复满意、持久。结论：用重建鼻下端两侧组织张力平衡的手术方法整复单侧唇裂继发鼻下端畸形,可获得可靠的治疗效果。     

单侧唇裂术后的鼻软骨解剖学研究

为探讨组织错位及组织发育不足与单侧唇裂鼻畸形的关系，对３８例伴有鼻畸形的单侧唇裂术后患者在鼻畸形修复术中的健患侧鼻翼软骨大小及相对位置进行观察和测量，发现均存在患侧鼻翼软骨错位，若伴有患侧鼻软骨发育不足则鼻畸形更加严重。说明患侧鼻软骨组织错位及发育不足是造成唇裂鼻畸形的局部因素。     

单侧唇裂术后继发鼻畸形的影响因素分析

目的：研究单侧唇裂术后继发鼻畸形的影响因素。方法：收集2005年1月—2006年12月就诊于中国医科大学口腔医院的单侧唇裂术后患者150例,拍摄患者正位、侧位和仰位照片,根据鼻尖、鼻翼、鼻小柱、鼻中隔、鼻背和骨组织畸形程度,对150例患者单侧唇裂术后继发鼻畸形的严重程度进行评价,分为轻度、中度、重度组,筛选性别、患侧、年龄、原有唇裂畸形严重程度、唇裂整复术术式、一期鼻整形术、牙槽突裂和上颌骨发育等因素,应用SPSS13.0软件包分析单侧唇裂术后继发鼻畸形形成中的影响因素。结果：鼻畸形严重程度分组符合评价一致率50%以上患者143例,轻度鼻畸形33例,中度鼻畸形65例,重度鼻畸形45例。性别和患侧对唇裂术后继发鼻畸形无显著影响（P〉0.05）,对唇裂术后继发鼻畸形有影响的因素为年龄（P=0.019）、唇裂严重程度（P=0.000）、唇裂整复术式（P=0.000）、一期鼻整形术（P=0.000）、上颌骨发育（P=0.000）和牙槽突裂（P=0.000）。结论：年龄、原有唇裂畸形的严重程度、唇裂术式选择、一期鼻整形术、上颌骨的发育程度及牙槽突裂是唇裂术后鼻畸形的影响因素。二期鼻整形术前,必须去除上述因素的影响,才能获得理想的术后效果。     

The central lip flap and nasal mucosal rotation advancement: important aspects of composite correction of the bilateral cleft lip nose deformity

The columella, nasal tip, lip relationship in the secondary bilateral cleft deformity remains an enigma and a great challenge for the cleft surgeon. A subset of patients with bilateral cleft lip still require columellar lengthening and nasal correction, despite the advances in preoperative orthopedics and primary nasal corrections. An approach to correct this deformity is described. This consists of (1) lengthening the columella by a central lip advancement flap; (2) open rhinoplasty, allowing definitive repositioning of lower lateral cartilages, ear cartilage grafting to the tip and columella when necessary; (3) nasal mucosal advancement; (4) alar base narrowing; and (5) reconstruction of the orbicularis oris as required. Depending on the individual assessment of the patients, some of these steps were not performed, leaving the nasal mucosal advancement the most important aspect of the reconstruction. In a consecutive series of 72 patients with repaired bilateral cleft lip and palate, 17 patients have been treated with nasal mucosal rotation advancement and followed up for a maximum period of 10 years. With the use of this technique, the secondary bilateral cleft lip nose deformity has been successfully corrected.     

Objective tools to analyze the lower lateral cartilage in unilateral cleft lip nasal deformities

Correction of cleft lip nasal deformity is an elusive goal. A controversy exists regarding the cause of the deformity, and therefore, there is a controversy of how to correct the deformity. Extrinsic theory is based on the presence of deformational forces from outside. The intrinsic theory is associated with deficiency of the lower lateral cartilage. The aim of this study was to use new objective tools to compare morphologically and histologically between the lower lateral cartilages of cleft and noncleft sides in patients with unilateral cleft lip nasal deformity. This study included 16 patients. They were operated on to correct unilateral cleft lip nasal deformity. Length, width, and thickness of lateral crura of the lower lateral cartilages of cleft and noncleft sides were measured. Punch biopsies from the middle part of the caudal ends of lateral crura were taken and sent for histologic and immunohistochemical studies. The lateral crura of the cleft side were significantly wider and shorter and tend to be thinner than those of the noncleft side. There was no significant difference in the chondroblast, chondrocyte, and total cellular number in the lower lateral cartilage of the cleft and noncleft sides. There was significantly less glycosaminoglycan content in the ground matrix of the lower lateral cartilage of cleft side. In conclusion, the use of digital sliding caliber in measuring the diminutions of the lower lateral cartilage and image analyzer to quantify the proteoglycans, glycosaminoglycans, fibroblast growth factor 18, and collagen content is very effective objective tools to compare the cleft and noncleft alar cartilage.     

Secondary correction of nasal abnormalities associated with cleft lip.

Approximately 30% of patients will require a second operation for correction of nasal abnormalities associated with unilateral cleft lip. In a single second operation, the following steps seem to give the most satisfactory correction: repositioning the nasal septum in the midline; altering the contour of the alar cartilage on the cleft side; and rotation of the axis of the external naris on the cleft side. The usual result following this combination of procedures is moderate but not complete correction of the abnormality. About 50% of the patients will need a second operation for correction of nasal abnormalities associated with bilateral cleft lip. Satisfactory correction of the bilateral cleft lip nasal deformity is usually obtained by lengthening the columella (which secondarily corrects a flat nasal tip) and narrowing the width of the nose at the level of the alae. Satisfactory restoration to normal is usually obtained by the aforementioned procedure.     

两类单侧不全唇裂鼻畸形临床特点的初步研究

目的：研究单侧不全唇裂伴有／和不伴有牙槽突裂患儿的唇、鼻部畸形特征。方法：对68例患者进行唇鼻部相关数据的测量研究,采用改良Mohler术式修复唇裂并同期矫正鼻畸形。结果：术前测量显示伴有牙槽突裂患儿的唇峰～鼻翼,唇峰～鼻小柱基底的距离,鼻孔高,鼻孔宽和鼻小柱高度与不伴有牙槽突裂的患儿相同指标有显著性差异。结论：通过测量数据的分析显示：单侧不完全性唇裂伴有牙槽突裂是一种畸形更为严重的不全唇裂。     

鼻畸形矫正术在初期唇裂修复术中的应用评价

目的：观察术前已完成鼻牙槽塑形矫治患儿在初期唇裂修补术中同期行鼻畸形矫正术对术后鼻外形的美观与对称效果的影响。方法：选择已完成术前鼻牙槽塑形矫治患儿69例,均采用改良旋转推进唇裂修复术实施手术。术中根据患侧外鼻形态恢复状况,确定是否行鼻畸形矫正术,其中32例行鼻畸形矫正术,37例未行鼻畸形矫正术。2组均采用术后第4～5年面容照片打分方式进行鼻外形评定。评定结果采用SPSS10．0软件包进行配对t检验。结果：唇裂修复术同期行鼻畸形矫正组和未行鼻畸形矫正组患儿,术后第4～5年鼻外形的美观与对称性平均得分为70．66±10．89和64．14±10．63．鼻畸形矫正组术后鼻外形显著优于未行鼻畸形矫正组,2组差异有统计学意义（P〈O．05）。结论：唇裂修复术中同期行鼻畸形矫正术的患儿,其术后鼻外形的美观与对称性进一步改善,且对外鼻的生长发育无不良影响。     

单侧唇裂鼻翼软骨定位术与再定位术的设计及应用

鼻畸形矫正日益成为唇裂治疗关注的重点,其术后高复发问题是亟需解决的技术难点.笔者前期提出了依据中国人群鼻翼形态特点建立的鼻翼软骨二焦点固定技术(鼻翼软骨内固定术),之后在单侧唇裂整复中又建立了鼻小柱侧方软组织增量的理论与技术.基于对这两种技术的应用和总结,笔者将其进一步相结合从而发展出新的鼻畸形整复方法,称之为鼻翼软骨...     

Comprehensive rhinoplasty technique to correct the bilateral cleft lip nasal deformity using conchal composite grafts.

INTRODUCTION: Anatomical abnormalities and heterogeneous tissue deficiencies of the bilateral cleft lip nasal deformity challenges the cranio-maxillofacial plastic surgeon to create a functional, yet aesthetically pleasing nose. The authors propose a comprehensive rhinoplasty technique to correct the bilateral cleft lip nasal deformity using composite conchal grafts. PATIENTS: Five children with bilateral cleft lip nasal deformities had nasal reconstruction using conchal composite grafts, averaging 5 years in age at time of surgery. Patient follow-up averaged 21 months. METHODS: An open tip rhinoplasty was performed using a 'V' shaped columellar incision. The conchal composite graft was obtained from the lateral aspect of the ear and was used to reconstruct the lateral alar mucosal defects. Conchal cartilage was used as a columellar strut. The columellar skin was closed in a 'V-Y' fashion, giving greater columellar length. RESULTS: Visual inspection confirmed that the cleft lip nasal deformity was improved in all patients. There were no postoperative complications. All patients had complete composite graft take with minimal donor site morbidity and deformity. CONCLUSIONS: This comprehensive rhinoplasty technique improves the abnormalities found in bilateral cleft lip nasal deformity by using the successful aspects of other methods and introducing the composite conchal graft.