黏膜瓣Z成形术矫正二期单侧唇裂鼻翼畸形

目的评估运用黏膜瓣Z成形术矫正鼻翼塌陷的治疗效果。方法 2011年12月至2013年6月,对46例二期单侧唇裂患者使用黏膜瓣Z成形术锁边,缝合大翼软骨和侧鼻软骨来矫正其鼻翼畸形。测量鼻小柱倾斜度和鼻孔宽度,并进行统计分析。结果患侧鼻孔的宽度、鼻小柱的倾斜度及鼻尖和鼻翼的对称性都有明显改善。41例患者术后随访6个月,3例患者出现了轻度复发,但其数据分析与术前比较仍有明显改善。结论黏膜瓣Z成形术可有效矫正单侧唇裂患者的鼻翼塌陷。     

Revision of the cleft lip nose

Secondary or revision rhinoplasty for the cleft nasal deformity represents one of the most challenging problems in rhinoplasty surgery. The secondary nasal deformity of the unilateral cleft lip involves a retrodisplaced dome of the ipsilateral nasal tip, hooding of the alar rim, a secondary alar-columellar web, and other deficiencies. This article discusses techniques to achieve the best possible outcome for patients with cleft nasal deformities. We emphasize the importance of early intervention by way of primary cleft rhinoplasty and highlight the typical challenges presented in delayed (secondary) or revision cleft rhinoplasty. We describe how the sliding flap cheilorhinoplasty effectively corrects these deformities using a laterally based chondrocutaneous flap via an open rhinoplasty approach. Columellar struts and shield grafts are some of the techniques combined with this approach to produce optimal results.     

Secondary rhinoplasty in nasal deformity associated with the unilateral cleft lip

The secondary nasal deformity of the unilateral cleft lip involves a retrodisplaced dome of the ipsilateral nasal tip, hooding of the alar rim, a secondary alar-columellar web, and other deficiencies. The sliding-flap cheilorhinoplasty effectively corrects these deformities using a laterally based chondrocutaneous flap. We modified this technique by using an open rhinoplasty approach with the laterally based chondrocutaneous sliding flap. Columellar struts and shield grafts were some of the techniques combined with this approach to produce optimal results. In a total of 7 patients, we performed both the original sliding-flap cheilorhinoplasty and the modified open rhinoplasty, which are described and discussed herein. The laterally based sliding-flap cheilorhinoplasty is an effective technique for correcting both the secondary nasal deformity and the lip scar associated with the unilateral cleft lip.     

单侧唇裂继发畸形整复术的术式改良

目的 探讨改良术式修复单侧唇裂术后继发唇、鼻畸形的效果.方法 手术切几线与口鼻轮廓线相一致,片使鼻翼外侧脚整体旋转复位,重建鼻槛及鼻底,通过鼻腔的V-Y黏软骨瓣使鼻翼软骨上推,矫正鼻畸形.结果 自2000年以来,应用此方法对69例单侧唇裂继发唇、鼻畸形患者进行了修复,均取得较满意的效果,术后瘢痕线不明显.结论 轮廓线切口以及鼻翼软骨上推复位的方法符合唇、鼻的解剖特征,是一种较好的手术方法.     

开放式唇裂继发鼻畸形整形术

目的：探讨单侧唇裂继发鼻畸形的手术治疗。方法：应用跨鼻小柱的鼻翼软骨下缘切口开放式鼻整形进行唇裂继发鼻畸形矫正,鼻小柱侧缘切口继续向下延伸至鼻小柱基底,将鼻小柱基部皮肤向下翻开,充分松解和暴露鼻翼软骨,矫正中隔畸形,将鼻翼软骨向前上内侧复位,与健侧鼻翼软骨、鼻背侧软骨缝合固定,必要时进行切取鼻中隔软骨移植以抬高鼻尖以及加强鼻穹窿。结果：应用本方法治疗单侧唇裂继发鼻畸形47例,单纯进行鼻畸形矫正者11例,同时行唇畸形整形者36例,效果满意,其中有32例进行了6～24个月的随访,平均随访时间为11个月,鼻外形良好。结论：应用开放式鼻整形技术进行唇裂继发鼻畸形矫正,可在直视下充分松解并显露鼻翼软骨,准确复位及缝合固定,术后效果稳定,切口无明显瘢痕。     

单侧唇裂继发鼻畸形修复新法

目的矫正单侧唇裂继发鼻畸形。方法基于对单侧唇裂鼻畸形的病理解剖学研究和对其畸形特征的认识,我们设计一种新的手术修复方法。手术经鼻端和患侧前庭联合切口,解剖、显露双侧鼻翼软骨,同时形成患侧前庭粘膜软骨瓣;在纠正鼻中隔软骨偏曲,松解患侧鼻肌复合体起点,使鼻翼脚无张力抬高后,再通过悬吊技术和粘膜软骨瓣的 V-Y 推进,将患侧鼻翼软骨进行整体旋转复位;最后,应用口轮匝肌上部纤维内收抬高鼻翼脚,用鼻肌复合体起点复位调整鼻孔形态,完成鼻畸形的矫正。结果自1993年至今,经92例实践,效果满意。结论本手术方法具有切口暴露好、可直视操作、安全可靠等特点;患侧鼻翼软骨整体复位具有良好的临床效果。     

单侧唇裂继发鼻畸形修复新法

OBJECTIVE: The aim of this work was to correct the secondary deformities of unilateral cleft lip nose. METHODS: On the basis of patho-anatomical study and the comprehension on the cleft lip nose, a new approach to correct the secondary deformities of unilateral cleft lip nose was designed and used. During operation, an intranasal and marginal combining incision was made to explore the alar cartilages and to from a mucosal-cartilage flap in the nasal vestibule. After the deformity of septal cartilage and the abnormalities of the alar base on the cleft side were repaired, the total alar cartilage was repositioned and rotated with suspension and V-Y advancement to correct the nasal deformities. RESULTS: Since 1993, a total of 92 cases were treated by the above procedure and satisfactory results were obtained. CONCLUSION: The clinical applications showed that there were several advantages for this method, and good results can be gained by repositioning the total alar cartilage on the cleft side.     

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临床整复

目的:对68例单侧唇裂术后鼻畸形整复术的患者进行回顾性分析,探讨鼻畸形整复的最佳治疗方式。方法:以68例唇裂术后鼻畸形患者为研究对象,男性45例,女性23例,年龄7~36岁,平均21.4岁,左侧41例,右侧27例。采用内收鼻翼外角、消除鼻前庭皱褶,鼻翼悬吊、矫正鼻翼塌陷,延长鼻小柱。术后持续戴鼻模3~6月。结果:68例患者开放性鼻畸形整复术后,随访59例(80.23%)共3~36月,术后效果达到优34例,良22例,差3例。无一例创口感染,鼻畸形得到明显改善。结论:单侧唇裂术后继发鼻畸形的整复治疗,通过对鼻翼软骨、鼻唇软组织等多方面的矫正修复,可明显改善鼻畸形。开放式的鼻畸形整复术是单侧唇裂术后继发鼻畸形治疗的有效方式。     

婴幼儿先天性唇裂早期修复同期行鼻畸形矫正初步报告

目的 探讨婴幼儿先天性唇裂早期修复,同期矫正鼻畸形,以避免唇裂术后继发鼻畸形而再次手术的可行性。方法,采用Millard I式或II式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 1998－1999共矫治30例,年龄3个月至3岁,单侧唇裂24例,双侧唇裂6例,随诊最长18个月,效果良好。结论 唇裂患儿幼小时组织比较薄膜,畸形易于矫正,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学位置并在此位置 生长发育,鼻畸形可望明显改善。     

Millard Ⅱ式手术矫正单侧唇裂术后继发畸形的分析

目的 分析Millard Ⅱ式手术矫正单侧唇裂术后继发唇鼻畸形的优点与手术要点.方法 2003年3月至2004年9月,对42例单侧唇裂术后继发畸形患者采用Millard Ⅱ式手术矫正,同时松解患侧鼻翼软骨与皮肤的粘连,应用埋没导引针悬吊鼻翼软骨,或切断其内侧脚后上提与对侧鼻翼软骨内侧脚缝合.结果 所有患者术后切口愈合良好.随访3～6个月,患侧鼻小柱延长,两侧鼻孔对称,人中嵴对称,唇弓形态好,无瘢痕增生.结论 Millard Ⅱ式手术是矫正单侧唇裂术后继发畸形的理想术式,同时松解、悬吊患侧鼻翼软骨能够更好地矫正鼻畸形.     

Correction of severe secondary cleft lip nasal deformity using a composite graft: current approach and review

In the case of a severe tissue deficiency with a secondary cleft lip nasal deformity, a composite graft can be useful for columellar lengthening or to create symmetrical nostrils. The current study used composite grafts to correct secondary cleft lip nasal deformities with a severe tissue deficiency or severe nostril asymmetry. A total of 19 patients who were born with complete cleft type were operated between 1995 and 1999. Of these patients, 10 were men and 9 were women, and the age distribution was 7 to 35 years old. In 9 patients with unilateral cleft lip nasal deformities and in 6 patients with bilateral cleft lip nasal deformities, columellar lengthening was performed using a composite graft taken from the helix in 14 patients and the contralateral alar rim in 1 patient. In 4 patients with severely asymmetrical nostrils resulting from a short alar rim in unilateral cleft lip nasal deformities, the ear helix was used in 2 patients, whereas in the other two patients, the alar rim of the unaffected side was transferred to the affected side to create a symmetrical nostril by reducing the length of the ala on the unaffected side. The follow-up period ranged from 1 to 3 years, and results were as follows: Four days after the graft, the composite tissue exhibited a pinkish color, and complete survival was confirmed after 7 days. The absorption rate was approximately 10% and the color mismatch became minimal with time. Composite tissue from the ear was found to be useful for full-layer reconstruction of the ala and columella because of its stiffness, thin nature, and similarity. Composite tissue from the alar rim on the contralateral side was also determined to be a good material for full-layer reconstruction of the deficient ala.     

牙槽裂植骨同期鼻中隔骨支架植入鼻整形术

目的　研究在牙槽裂植骨修复的同时 ,利用自体髂骨皮质板块 ,修复单侧唇腭裂鼻畸形。方法　 10岁以后的单侧完全性唇腭裂患者 ,采用自体髂骨松质骨移植修复牙槽裂 ,同时采取髂骨内侧骨皮质修整后植入两侧鼻翼软骨内侧脚之间 ,形成鼻中隔前下部的骨性基础支架 ,将分离复位的鼻翼软骨内侧脚提升 ,使软骨穹窿顶超过骨性支架的上缘约 3mm ,将软骨缝合固定于骨性支架。结果　本组 2 4例患者均一期痊愈出院 ,患侧鼻翼基部凹陷、鼻小柱偏斜、鼻尖低平等畸形得到良好的矫正。结论　牙槽裂植骨与鼻畸形整复同期进行互不干扰。鼻中隔前骨性支架对鼻的外形结构有良好的支持作用 ,可以有效地矫正唇腭裂鼻畸形 ;与牙槽裂植骨同期进行 ,取材方便 ,减少了手术及麻醉的次数。     

Nasal Deformities and their Treatment in Secondary Repair of Cleft Lip Patients:A Clinical Study of 175 Cases

The author reports his own experience in 175 cases of secondary repair of cleft lip nose deformities. In spite of the great variability of these cases a relatively simple strategy has been defined, based on a precise study of the lesions. In unilateral cases the nose is deviated entirely to the normal side, not only because of nasal bone deviation but also and mainly because of septal deviation. The nasal tip is distorted because of the alar cartilage displacement which results from bone deviation. Rhinoplasty is usually performed by a submucosal approach through a vertical incision in the columella. It includes septal straightening, nasal osteotomies, and sharp dissection and reduction of the triangular cartilages and alar cartilages to allow of their suturing in the normal position. In bilateral cleft lip cases the main deformity of the nose is shortness of the columella. Here, two techniques have been utilized. In those rare cases where the lip was correct in height and width, a V—Y plasty on the nasal tip was performed with good results. In most cases the Abbe-Estlander flap was the procedure of choice. These rhinoplasties were carried out on patients between 15 and 20 years of age, and were always considered to be the last stage of secondary cleft lip repair, particularly after the maxillary bone defects had been corrected.     

单侧唇裂继发鼻畸形修复新法

目的　矫正单侧唇裂继发鼻畸形。方法　基于对单侧唇裂鼻畸形的病理解剖学研究和对其畸形特征的认识,我们设计一种新的手术修复方法。手术经鼻端和患侧前庭联合切口,解剖、显露双侧鼻翼软骨,同时形成患侧前庭粘膜软骨瓣;在纠正鼻中隔软骨偏曲,松解患侧鼻肌复合体起点,使鼻翼脚无张力抬高后,再通过悬吊技术和粘膜软骨瓣的 Ｖ Ｙ 推进,将患侧鼻翼软骨进行整体旋转复位;最后,应用口轮匝肌上部纤维内收抬高鼻翼脚,用鼻肌复合体起点复位调整鼻孔形态,完成鼻畸形的矫正。结果　自１９９３ 年至今,经９２ 例实践,效果满意。结论　本手术方法具有切口暴露好、可直视操作、安全可靠等特点;患侧鼻翼软骨整体复位具有良好的临床效果。     

唇裂术后继发畸形的功能性修复

目的：探讨唇裂术后继发鼻唇畸形功能性修复的美容效果。方法：主要针对鼻翼畸形、鼻孔不对称等进行手术，分离鼻翼软骨并抬高内侧脚，缩小鼻孔基底，纠正鼻翼塌陷畸形。结果：1998年以来，共收治32例患者，随访1～4年，效果满意。结论：充分游离鼻翼软骨并使其复位到与对侧对称，消除了鼻畸形的病理基础，从而保证了畸形修复的远期效果。     

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。     

鼻表浅肌肉腱膜瓣在特殊鼻畸形整复中的应用

目的:探索特殊鼻畸形的有效整形修复方法.方法:对34例鼻畸形,其中先天性鼻窦道13例,先天性鼻眶裂2例,先天性鼻裂7例,双侧唇裂继发鼻畸形12例,应用鼻表浅肌肉腱膜瓣修复.结果:本组病例术后双侧鼻翼及双侧鼻孔均对称,鼻表情运动和鼻孔舒缩功能恢复.平均随访9个月,均效果满意.结论:应用鼻表浅肌肉腱膜瓣修复特殊鼻畸形是一种安全有效的方法.     

单侧唇裂继发鼻畸形整复的临床研究

目的:探讨对单侧唇裂鼻畸形的修复和方法选择。方法:以115例单侧唇裂鼻畸形患者为研究对象,针对不同的鼻畸形状况,选择相应的手术方式。以高密度多孔聚乙烯生物材料充填患侧鼻翼基底,弥补上颌骨发育不足;采用悬吊患侧鼻翼,纠正鼻翼塌陷畸形;解剖复位鼻唇肌,矫治鼻翼基底外下方移位及鼻小柱偏斜;矫治鼻中隔偏曲,以纠正鼻下端的歪鼻畸形;术后采用有效的维持措施。结果:术后115例患者的鼻畸形均得到不同程度的改善,随访时间6~12个月,32例植入生物材料的患者,均未发生材料的排异反应。6例患者术后有复发倾向。结论:采用此综合手术方法矫治单侧唇裂继发鼻畸形,效果满意、持久。