自体鼻中隔软骨联合耳廓软骨的鼻中隔延伸物移植术在鼻尖整形中的应用

目的探讨运用鼻中隔软骨联合耳廓软骨构建鼻中隔延伸物复合体重置鼻尖位置和重塑鼻尖形态的可行性。方法 2018年9月至2019年10月,以中国医学科学院整形外科医院17例低鼻患者为研究对象,17例患者中男2例,女15例;年龄19~39岁,平均27岁。17例患者均为初次鼻整形病例。术中在全身麻醉下行鼻整形术。切取鼻中隔软骨作为鼻中隔延伸移植物延长鼻中隔尾端;切取自体耳廓软骨制备成:撑开移植物、鼻小柱支撑移植物、抗回缩移植物、帽状移植物,以加强支架的稳定性及抬高鼻尖,调整鼻尖形态。鼻背使用膨体材料充填。运用数字化面部扫描技术对术前术后鼻部结构进行测量。以SPSS 22统计软件对相关数据行配对t检验。结果术后平均随访6~12个月,平均7.6个月。17例患者均对术后鼻形态、鼻长度、鼻尖高度满意。鼻尖触感自然,无感染,无假体移位、皮瓣坏死,无耳廓变形等并发症。术后鼻长增加(3.60±0.77)mm、鼻尖高度增加(3.61± 0.64)mm;较术前差异有统计学意义(t值分别为-19.203、-23.132,P值均<0.001);鼻唇角较术前减小(3.40±2.11)°,差异有统计学意义(t=6.635,P<0.001)。结论运用鼻中隔软骨联合耳廓软骨构建鼻中隔延伸物复合体重置鼻尖位置和重塑鼻尖形态具有可行性。

Application of septal extension graft with autogenous septal cartilage and auricular cartilage in rhinoplasty

Objective To explore the feasibility of reconstruction of nasal tip with septal cartilage and auricular cartilage.Methods From September 2018 to October 2019,17 patients(two males and fifteen females)with low noses underwent rhinoplasty under general anesthesia.The age of the patients ranged from 19 to 39,with an average of 27 years old.Among them,all the 17 cases were primary rhinoplasty.During the operation,autologous nasal septum cartilage was used as septal extension graft to extend the caudal septum,and the auricular cartilage was used to enhance the stability of the strut and to elevate the tip for adjusting the shape of nose by making into spreader graft,columellar strut graft,derotation graft and onlay graft.The nasal dorsum was filled with polytetrafluoroethylene.Digital scanning technology was used to evaluate the nasal structure before and after operation.SPSS 22 software was used to analyze the data with paired t-test.Results The follow-up was from 6 to 12 months,with an avaerge of 7.6 months.Seventeen patients were satisfied with postoperative nasal morphology and height.There was no infection,prosthesis displacement,skin flap necrosis,no auricle deformation and other complications.Statistical software SPSS 22 performed paired t-test on the preoperative and postoperative data obtained by digital technology:postoperative nasal length and nasal tip protrusion increased compared with that before surgery,and it was statistically significant(length:(3.60±0.77)mm,tip protrusion:(3.61±0.64)mm,t value was-19.203 and-23.132 respectively,both P<0.001).The nasolabial Angle was smaller than that before surgery,and the data were statistically significant(3.40°±2.11°,t=6.635,P<0.001).Conclusion The nasal tip and nasal septum extension complex constructed by autogenous nasal septal cartilage combined with auricular cartilage can increase the length of nasal tip,increase the height of nasal tip and reduce the angle of nasolabial angle.