单侧唇裂术后继发鼻畸形分级和术式选择

目的 探讨患者鼻底凹陷的分级,为修复唇裂鼻畸形术后鼻底高度不足的手术方式选择提供参考. 方法 对2008年7月至2009年2月收治的26例单侧唇裂继发鼻畸形的患者,通过三维CT测量上颌骨,结合手术前后鼻部软组织的测量,探讨鼻翼基部软组织和上颌骨的关系,结合患者满意度对鼻畸形进行分级. 结果 鼻翼基部的位置与梨状孔的形态不具有相关性,但鼻翼基部骨缺损与患者的满意度相关,当双侧鼻翼基部凹陷程度＜4.5 mm为1级,仅通过软组织整复即可获得满意的鼻部形态;2级为鼻翼基部凹陷程度介于4.5～5.0 mm,此时可仅进行软组织修复或使用假体充填,具体病例需结合患者要求与临床实际来判断;3级为鼻翼基部凹陷程度＞5 mm,需要联合自体骨或假体的植入或牙槽突裂的整复才能得到满意的效果. 结论 在唇裂术后继发鼻畸形患者中,上颌骨的凹陷并不一定会导致术后鼻翼基部的凹陷,鼻翼基部可以通过手术调整到一个很好的位置.在鼻畸形矫正术前需要结合患者鼻部的测量来选择手术方式,以得到满意的效果.

Abstract：

Objective To investigate the classification of alar base depression,so as to provide the reference for the surgical management of secondary nasal deformity of unilateral cleft lip. Methods From Jul.2008 to Feb.2009,26 cases with sceondary deformity of unilateral cleft lip were treated.All the patients underwent 3-dimensional CT for maxillary measurement.The nasal soft tissue measurement was performed pre-and post-operatively.The relationship between the maxillary and soft tissue at alar base was analyzed.The nasal deformity was classified. Results The location of alar base was not related to the form of piriform aperture,but the bony defect at the alar base was correlated to the patient satisfactory.The nasal deformity was graded as Ⅰ when the depression at alar base was less than 4.5 mm in depth,as Ⅱ when it was 4.5-5.0 mm in depth,and as Ⅲ when it was more than 5 mm in depth.The deformity could be corrected with only soft tissue plasty for grade Ⅰ,with soft tissue plasty or artificial implants for grade Ⅱ,with combined bone autograft or alveolar cleft repair for grade Ⅲ. Conclusions The depression at maxillary does not necessarily result in alar base depression.The alar base can be adjust to proper position through operation.The operation should be designed based on the preoperative nasal measurement.     

Nasal sill reconstruction with the Abbe flap after skin cancer resection: A case report

Local flaps are widely known as the best option for partial nasal reconstructions depending on donor tissue laxity,vascularization, and defect shape and size. The nasolabial flap is used more often in the nasal sill. For larger defects, greater tissue mobilization with larger scars or free flaps is required. Historically, the Abbe flap has been used for lip reconstruction in patients with cleft lip deformities. It allows less retraction than other local flaps or skin grafts in patients with larg...     

鼻保持模在唇裂鼻畸形治疗中的应用

唇裂鼻畸形通常指与唇裂同时伴发的先天性固有的鼻部软组织和软骨畸形.虽然唇裂Ⅰ期鼻畸形整复术或Ⅱ期鼻畸形整复术可以较理想地恢复鼻孔及鼻翼形态,但由于先天性鼻软骨发育异常、肌动力平衡失调、犁状孔形态异常,以及手术操作的差异、术后瘢痕挛缩等原因,还可能导致唇裂术后继发鼻畸形.鼻保持模(nasal conformer,nasal splint,nostril retainer)的应用可有效抵抗唇裂鼻畸形术后瘢痕挛缩,同时可以引导鼻部发育,减少继发鼻畸形的发生.     

Total Nasal Tip Defect:Bilateral Lateral Nasal Artery Flaps for Lining Reconstruction

Background In full-thickness nasal defects,the internal lining is perhaps the most challenging aspect of the three layers to rebuild.Nasal damage is usually more concentrated on the tip,soft triangles,alar wings,and columella,but the lateral nasal arteries are often left intact and the damage to the dorsal sidewalls are normally superficial.Methods Twelve patients who required total nasal reconstruction received a forehead flap placement as external coverage and autologous rib cartilage as structural support.Residual normal/superficial scar tissue flaps on the dorsal sidewalls with lateral nasal artery pedicles were mobilized and designed for internal lining repair without creating secondary donor site damage.The flaps were then turned 180°downward and placed between the alar medial angles and the fornix.Results No total lining flap necrosis occurred in all the patients.Partial necrosis occurred on the distal edge owing to overpressure of the nostril splint to the flaps;however,the wounds eventually healed,and the nasal structural integrity was preserved.The patients were satisfied with the aesthetic results and had no complaints of airway stenosis.Conclusions Lateral nasal artery pedicle dorsal sidewall skin flaps are appropriately thick,providing enough nostril circumferential support to improve airway stenosis.It allows sufficient blood supply and creates no extra donor site damage.Blood vessels and skin flaps are often undamaged,thereby allowing maximum application in total nasal reconstruction.     

完全性单侧唇裂鼻唇畸形的同期修复

目的 探讨完全性单侧唇裂鼻唇畸形同期修复的时机、手术方法及围手术期的序列治疗对手术效果的影响.方法 收集完全性单侧唇裂病例76例,手术年龄为3～12个月.手术方法采用鼻唇畸形同期修复方法,参考Salyer及Noordhoof法的手术原则,并根据具体情况灵活设计,配合术前、术后的序列治疗.结果 完全性单侧唇裂鼻唇畸形同期修复术后随访时间为3个月至20年.总体鼻唇形态恢复满意.其中,优秀39例(51.3%),满意33例(43.4%),不满意4例(5.3%).结论 早期鼻唇畸形同期修复,配合围手术期的序列治疗,以及整形外科或颌面外科医师纯熟的手术技巧,尽最大可能减少损伤和瘢痕,会达到理想的修复效果.

Abstract：

Objective To investigate the influence of timing, operative method and perioperative sequence treatment on the therapeutic effect of one-staged correction of lip and nose deformities in complete unilateral cleft lip. Methods Seventy-six patients with unilateral complete cleft lip, aged from 3 to 12 months, underwent one-staged correction of lip and nose deformities, based on the Salyer, Noordhoof method. Sequence treatment was performed before and after operation. Results The patients were followed up for 3 months to 20 years with excellent results in 39 cases ( 51. 3% ) , good in 33 patients (43. 4% ) , unsatisfied in 4 patients( 5. 3% ). Conclusions Good results can be achieved when the onestaged correction of lip and nose deformities, combined with perioperative sequence treatment, is performed. The operative technique of plastic surgeon or maxillofacial surgeon is also important for less morbidity and scar.     

梯度旋转下降法修复单侧完全性唇裂

Objective To explore the clinical effect of the method of rotation descent step by step for unilateral complete cleft lip with. Methods The method of rotation descent step by step was used to repair unilateral complete cleft lip. Point X was located on the angular bisector of ∠ 123, rotation descent step by step and orbicularis otis degloved dissection were used. Nasal deformities were corrected at the same stage. Results From Oct. 2006 to Oct. 2008, 68 cases were treated with primary healing. 42 cases were followed up for less than one year. Among them, 3 cases showed asymmetric lip height, and 6 cases showed asymmetric lip width. 26 cases were followed up more than one year with only two cases of asymmetric lip width. Conclusions The method of rotation descent step by step is very suitable for repairing unilateral complete cleft lip. The restoration of the malpositioned tissue is especially emphasized in this method.     

应用螺旋CT三维重建鼻骨形态鼻内镜下歪鼻矫正术

目的 探讨应用螺旋CT三维重建鼻骨形态鼻内镜下矫正歪鼻畸形的手术治疗方法.方法 对66例歪鼻畸形患者术前行螺旋CT三维重建鼻骨形态,了解歪鼻畸形的局部形成状况.先在鼻内镜下行鼻中隔偏曲的矫正术,后经鼻前庭前小切口在鼻内镜辅助下行歪鼻畸形矫正.结果 术后1周、1个月、3个月及半年后随访,观察外鼻形状,并测量其偏离值.66例歪鼻中矫正效果优为53例,良好为11例,不满意2例.结论 螺旋CT三维重建鼻骨形态可在术前充分了解歪鼻畸形局部及周围情况;采用鼻内镜能充分暴露骨折畸形愈合部位,避免破坏整体框架,使得手术创伤小,手术时间短,术后反应轻,皮肤坏死可能性减小等,因此应用螺旋CT三维重建鼻骨形态鼻内镜下矫正歪鼻畸形效果更具优势.

Abstract：

Objective To discuss the endoscopy-assisted surgery for deviated nose with the preoperative 3-D CT reconstruction. Methods Sixty-six cases with deviated nose deformities underwent preoperative 3-D CT reconstruction. The deformities were showed in detail. The deviated nasal septum and deviated nose were corrected with the assistance of nasal endoscopy. Results The patients were visited after operation at 1 week, 1 month, 3 months and 6 months. The nose shape and nose deviation were measured. Among the 66 cases, satisfactory result was achieved in 53 cases, good in 11 cases,unsatisfactory in 2 cases. Conclusions Preoperative CT reconstruction is very help in understanding the deviated nose deformity. The rhinoplasty with nasal endoscopy has good exposure of the fracture deformity with less morbidity and side effect. The intraoperative time can be decreased also.     

单侧唇裂术后继发鼻孔过小畸形的矫正

目的:探索一种单侧唇裂术后继发鼻孔过小畸形的手术矫正技术。方法:选择2008年1月～2011年11月在我院因单侧唇裂术后继发鼻孔过小畸形行手术治疗的患者12例。在相对鼻孔较大的健侧设计蒂在鼻小柱下的皮瓣,将皮瓣向患侧旋转,用于扩大患侧鼻孔,同时可矫正患者鼻孔过小伴发的鼻小柱向患侧偏斜畸形。结果:所有患者经过此种手术方法修复后鼻外形明显改善,两侧鼻孔大小基本对称,鼻小柱居中,效果满意。结论:鼻小柱下健侧皮瓣旋转开大患侧鼻孔是一种有效矫正唇裂术后继发鼻孔过小畸形的方法。     

自体肋软骨支架在唇裂继发鼻畸形矫正中的应用

目的 探讨应用自体肋软骨支架矫正唇裂继发鼻畸形的临床效果.方法 64例唇裂继发鼻畸形患者,单侧51例,双侧13例,年龄16～38岁,平均21岁.其中包括鼻小柱短缩、偏斜,鼻尖低平,鼻孔不对称,鼻翼塌陷.根据鼻畸形取自体肋软骨经雕刻后,植入鼻中隔两侧与创腔前部,形成新的软骨支架,改塑鼻尖及鼻外形.结果 术后切口愈合良好,供区无并发症发生.鼻外形满意,鼻小柱延长,鼻尖高度提升明显,双侧鼻孔基本对称,鼻翼塌陷改善满意.64例均获随访3个月至2年,无软骨变形、排出.结论 自体肋软骨取材方便,不发生排斥反应,将软骨支架应用于唇裂继发鼻畸形矫正,可良好改善鼻外形,尤其是鼻尖外形及高度.     

乳腺组织瓣联合真皮帽悬吊术矫正轻中度乳房下垂

目的 探讨乳腺组织瓣旋转联合真皮帽悬吊的垂乳上提技术矫正轻中度乳房下垂的临床效果.方法 根据乳房下垂程度设计形成真皮帽后,分离乳房皮肤和腺体,于乳腺外上方行部分腺体切除或直接纵行切开腺体,并同时形成外侧腺体瓣,掀起腺体瓣向内侧旋转固定,缩小乳房基底,再行真皮帽上提固定和乳房塑形.结果 2006年3月至2010年3月,于临床应用46例,术后效果满意,其中2例出现单侧血肿,无其他严重并发症.对40例患者随访6个月至4年,乳房外形满意,无继发下垂、乳房扁平、乳头乳晕感觉障碍等并发症.结论 乳腺组织瓣旋转联合真皮帽悬吊垂乳上提术可商塑造饱满、坚挺的乳房,术后瘢痕不明显,远期效果满意.

Abstract：

Objective To investigate the therapeutic effect of glandular flap combined with dermal flap suspension for correction of mild and moderate breast ptosis. Methods The dermal flap was formed according to the breast ptosis and dissection was performed between the skin and gland. The superior-lateral gland was partially resected or cutted vertically only to form the lateral glandular flap. Then the glandular flap was rotated medially and fixed to shrink the glandular base area. Then the breast was up-positioned and fixed with dermal flap to remodel the breast shape. Results From Mar. 2006 to Mar. 2010, 46 cases were treated with satisfactory result. There was no severe complication, except for 2 cases of unilateral hematoma. 40 cases were followed up for 6 months to 4 years with good breast shape. No secondary ptosis,breast flatten and NAC sensation disorder was happened. Conclusions Glandular flap combined with dermal flap suspension is a good method for mild and moderate breast ptosis with reliable long-term results.The breasts have busty appearance and good projection with inconspicious scar.     

单侧唇裂术后继发鼻孔过小的整复术

目的探讨矫正唇裂术后继发鼻孔过小畸形的更有效方法。方法将患侧上唇较之对侧不对称的“多余”组织形成局部皮瓣,用于扩大鼻孔,同时调整鼻翼位置。结果8例患者用此种方法修复术后,在两侧鼻翼、鼻孔、鼻槛等方面基本对称,取得满意效果。结论患侧上唇皮瓣加鼻翼复位是一种有效矫正唇裂术后鼻孔过小畸形的方法。     

单侧唇裂修复同期鼻畸形矫正术

目的 探讨在修复伴有鼻畸形的先天性唇裂时,同期一次性矫正鼻部畸形,以最大程度地减少唇裂术后继发性鼻畸形发生的手术方法.方法 采用Millard术式或Millard术式＋三角瓣插入法,同时利用唇裂手术切口入路恢复大翼软骨、鼻肌及鼻小柱的正常解剖位置以矫正鼻畸形.结果 共修复单侧唇裂108例,术后随访1个月至3年,效果满意.结论 所有单侧唇裂均伴发鼻畸形,在唇裂修复同期进行鼻畸形的矫正,可获得即刻的手术效果和较为满意的远期疗效,并可能减少再次手术及手术难度.     

单侧完全性唇裂术后鼻唇畸形的修复

目的：介绍一种综合术式一次性整复单侧完全性唇裂术后鼻唇畸形的方法。方法：采用一针法鼻小柱鼻翼脚复位固定,以缩窄和平齐鼻底;利用埋没导引针修复鼻翼软骨复位,改善鼻孔形状;带侧翼鼻假体隆鼻突出鼻部和加高鼻翼;上唇M瓣成形修整唇红缘重建唇弓;两红唇瓣覆盖修复红唇部等。结果：单侧完全性唇裂术后继发鼻唇畸形32例,随访20例6个月～2年,外观和效果满意。结论：应用埋线法修复鼻小柱、鼻翼脚、鼻翼软骨复位,M成形术和两红唇瓣覆盖修复红唇部等术式是值得推荐的一次性整体修复继发鼻唇畸形的方法。     

应用假体矫正单侧唇裂术后鼻孔基底凹陷畸形

目的探讨矫正唇裂术后鼻孔基底凹陷畸形的方法。方法对24例患有唇裂术后鼻唇畸形的患者进行手术,切除上唇瘢痕,重建口轮匝肌,矫正红唇凹陷,提高患侧鼻翼,在患侧的梨状孔周围用膨体雕刻成预定的形状并进行填充。结果24例患者中,有2例因出现感染而取出假体,其余效果满意。结论对于错过了牙槽骨植骨仍存在鼻孔基底凹陷的患者,在矫正鼻唇畸形的同时,可采用膨体填充患侧鼻孔基底的凹陷。     

单侧完全性唇裂术后鼻唇畸形的修复

目的：介绍一种综合术式一次性整复单侧完全性唇裂术后鼻唇畸形的方法。方法：采用一针法鼻小柱鼻翼脚复位固定,以缩窄和平齐鼻底;利用埋没导引针修复鼻翼软骨复位,改善鼻孔形状;带侧翼鼻假体隆鼻突出鼻部和加高鼻翼;上唇M瓣成形修整唇红缘重建唇弓;两红唇瓣覆盖修复红唇部等。结果：单侧完全性唇裂术后继发鼻唇畸形32例,随访20例6个月～2年,外观和效果满意。结论：应用埋线法修复鼻小柱、鼻翼脚、鼻翼软骨复位,M成形术和两红唇瓣覆盖修复红唇部等术式是值得推荐的一种一次性整体修复继发鼻唇畸形的方法。     

Correction of cleft lip nasal deformity in Orientals using a refined reverse-U incision and V-Y plasty.

A total of 45 patients with cleft lip nasal deformities were operated on between September 1997 and December 1999. We reviewed 35 of them. Out of these, 31 patients had unilateral cleft lip nasal deformities and four patients had bilateral cleft lip nasal deformities. The age range of the patients was from 3 years to 56 years. A reverse-U incision with V-Y plasty was used in 20 patients with mild to moderate unilateral cleft lip nasal deformities. An open rhinoplasty incision combined with the reverse-U incision and V-Y plasty was used in 11 patients with severe unilateral cleft lip nasal deformities. A bilateral reverse-U incision and a trans-columellar incision were used in the four patients with bilateral cleft lip nasal deformities. After advancement of the mucochondrial flap, alar transfixion sutures were used to ensure firm contact between the nasal skin and the redraped reverse-U flap. A composite graft for columellar lengthening was used in six cases of severe unilateral cleft lip nasal deformity and the four cases of bilateral cleft lip nasal deformity. Ancillary procedures included correction of a lateral displacement of the alar base, lip scar revision, a cartilage graft for tip augmentation, iliac bone grafting for correction of hypoplasia of the maxilla or for an alveolar cleft and corrective rhinoplasty. A self-made nasal retainer was applied for 6 months in all patients to maintain the corrected contour of the nostril. The follow-up period ranged from 11 months to 26 months, with an average of 18 months. The final results were evaluated based on the degree of symmetry of the nostrils, the redraping of the alar-columellar web and the exposure of the nostrils. Good results were obtained in 29 patients where alar-columellar web deformities were either absent or minimal and a satisfactory symmetry of the nostrils was achieved. Four patients had fair results and two patients had poor results. In conclusion, we suggest that the reverse-U incision with V-Y plasty is a useful method for achieving symmetry of the nostrils in cleft lip nasal deformities in Orientals. In addition, this technique provides ample advancement and repositioning of the mucochondrial flap and simultaneous correction of the nasal vestibular web.     

髂骨片移植辅助鼻翼软骨悬吊矫正唇裂鼻畸形

目的探讨一种矫正单侧唇裂继发鼻畸形的有效、可靠方法。方法对61例单侧唇裂鼻畸形患者,采用患侧鼻翼外侧脚基底部颌骨骨膜下皮质骨片贴敷移植,鼻翼软骨内侧脚间植入髂骨皮质骨片,依健侧鼻孔形态,选择鼻翼软骨截断部位和悬吊方式,重建鼻翼软骨肌肉环,术后保持3个月。结果本组61例患者随访3～24个月,56例效果稳定,5例术后出现轻度复发。结论单侧唇裂继发鼻畸形成因复杂,通过颌骨、鼻翼软骨、鼻唇肌肉组织的综合矫治,可有效地改善畸形;稳定牢固地悬吊可增强疗效稳定性、减少畸形的复发率。     

解剖矫正及鼻中隔软骨修复单侧唇裂继发鼻畸形

目的 探讨应用解剖矫正及鼻中隔软骨修复单侧唇裂继发鼻畸形的方法及临床疗效.方法 对21例单侧唇裂继发鼻畸形患者,采用鼻小柱及双侧鼻前庭Goodman切口,佩戴2.5倍放大镜,镜下充分剥离及矫正鼻畸形错位解剖至正常位置,通过切取鼻中隔软骨,并重新搭建鼻尖的支架系统,重塑鼻外形.结果 手术分别纠正了鼻翼塌陷、鼻小柱偏斜、鼻孔不对称等问题,术后1个月、15个月随访21例,可见切口愈合良好,鼻形态改善明显,鼻小柱居中、鼻翼无塌陷、鼻孔基本对称,无明显复发,无并发症发生.结论 在鼻部解剖基础上,充分矫正鼻畸形错位解剖至正常位置,通过切取鼻中隔软骨,并重新搭建鼻尖的支架系统,重塑鼻外形,有良好的治疗效果.     

单侧完全性唇裂术后继发鼻唇畸形的一次性修复

目的：介绍一种综合术式一次性整体矫正单侧完全性唇裂术后继发鼻唇畸形的方法。方法：采用一针法鼻小柱鼻翼脚复位固定，以缩窄以平齐鼻底；穹隆MT瓣成形术改善鼻孔形状；带侧翼鼻假体隆鼻突出鼻部立体感和加高鼻翼；上唇M瓣成形修整唇红缘重建唇弓；双侧口角为蒂的唇黏膜瓣或下唇瓦合式黏膜瓣修复上唇唇红过薄、过短或部分缺损。结果：单侧完全性唇裂术后继发鼻唇畸形21例，随访10例3个月至1年，外观和效果满意。结论：应用一针法鼻小柱鼻翼脚复位加MT成形术和双蒂唇黏膜瓣移植等术式是值得推荐的一种一次性整体修复继发鼻唇畸形的方法。     

单侧唇裂继发鼻畸形的修复

目的 通过分析单侧唇裂鼻畸形成因、病理解剖改变,探索修复单侧唇裂继发鼻畸形有效可靠的方法.方法 57例单侧唇裂继发鼻畸形患者,采用颌骨裂隙植骨,鼻翼软骨两内侧脚间植入髂骨皮质骨片,依健侧鼻孔形态,选择鼻翼软骨截断部位和悬吊方式,重建鼻翼软骨肌肉环,术后用管状支撑物插入鼻孔保持3个月.结果 术后将鼻翼塌陷、鼻尖、鼻孔、鼻小柱与术前对比评价,满意率为93%（53例）.术后随访3～24个月,52例疗效稳定,5例出现轻度复发.结论 单侧唇裂继发鼻畸形成因复杂,通过颌骨、鼻翼软骨、鼻唇肌肉组织的综合矫治,可有效地改善畸形.并通过稳定牢固的悬吊和恢复肌力的平衡,增强疗效的稳定性,可有效地改善畸形.