功能性鼻整形手术的相关解剖进展北大核心CSCD

鼻部支架是由上1/3的骨性支架和下2/3的软骨支架构成的三棱锥体结构,是鼻外形和功能的解剖结构基础。功能性鼻整形手术主要通过调整骨和软骨性支架的异常,达到外形和功能的同期改善。本文介绍了外鼻美学特征、鼻部皮肤软组织结构、鼻部支架(包括骨和软骨性鼻锥)、鼻小叶和鼻腔,并提出鼻背软骨的概念,对键石区在功能性鼻整形中的作用有了新的认识,强调了隔背软骨的重要性。功能性鼻整形手术前,要准确定位引起表面标志异常和通气功能障碍的解剖部位,精准手术,才能获得患者和医生均满意的效果。     

我国汉族女性鼻整形手术的研究进展

随着鼻整形手术技术的发展,对填充材料的使用有了更多、更深刻的理解。近年来,我国整形外科的专家们,针对汉族女性鼻部的美学特征,以及不同填充材料的应用特点,设计了一系列更精确的手术方式,使鼻整形手术更趋完善。结合汉族女性的鼻部特点,对鼻背部整形、鼻尖部整形、鼻整形术后并发症及鼻整形材料的使用情况进行总结分析。     

功能性鼻整形的解剖学进展

随着整形外科技术的不断发展,功能性鼻整形外科因其需要同时改善患者鼻部的外观及功能而受到广泛关注。本文旨在梳理近年来功能性鼻整形领域的解剖学进展,对鼻部与功能相关的重要结构的解剖学研究进行回顾,为功能性鼻整形临床研究与实践提供理论基础和参考。     

鼻综合整形手术病人中耳软骨的应用意义探讨

目的 研究鼻综合整形手术患者中应用耳软骨的效果。方法 数据遴选本院2019年1月-2021年11月收治的48例鼻综合整形手术患者,“手术使用材料差异”分硅胶组(硅胶,n=24)、研讨组(耳软骨,n=24),2组疗效比较。结果 治疗前比较2组临床指标无差异,P>0.05;治疗后与硅胶组比较,研讨组鼻唇角、鼻梁偏斜角更低,鼻额角、鼻尖突出度更高;手术、住院时间更短;研讨组满意率(95.83%)高于硅胶组(75.00%),研讨组并发症率(8.33%)低于硅胶组(33.33%),χ²=4.181,4547;P=0.041,0.033,P<0.05(具有统计学意义)。结论 耳软骨用于鼻综合整形手术治疗中可改善治疗情况,缩短手术、住院时间,提高满意度、减少并发症发生,值得推崇。     

鼻外伤畸形的功能性鼻整形术

功能性鼻整形是通过调整鼻部的解剖结构来改善鼻通气功能,同步改善外鼻的面部表情及美观功能的手术技术。本文围绕“鼻外伤畸形”这一专病,结合大量的国内外文献,阐述了功能性鼻整形术的各种要点,详细叙述了鼻骨骨折、鼻眶筛骨折、鼻中隔骨折和偏曲.外伤后鼻畸形和鼻瓣区畸形5种疾病.同时介绍了在行功能性鼻整形术前后的主观性和客观性评估方法。     

鼻整形相关功能问题探讨北大核心CSCD

功能性鼻整形主要通过改变解剖结构进而改善鼻腔通气功能,实现外形和功能的统一,其中既包括异常结构的矫正,也包括正常结构的保护。本文结合近年发表的文献和临床实践,对鼻部结构与功能的关系、鼻部结构与外形的关系、鼻整形术对鼻腔通气功能的影响,以及保留性鼻整形等方面进行阐述,以期提高读者对鼻整形相关功能、尤其是鼻阻塞问题的理解和认识。     

单纯鼻部手术对伴有鼻阻的阻塞性睡眠呼吸暂停低通气综合征患者睡眠的影响

目的 探讨对伴有鼻阻塞的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者,仅单纯行鼻部手术,术后对患者睡眠质量、结构、体位及紊乱性睡眠呼吸(SDB)的影响。方法 对鼻阻塞OSAHS患者30例鼻部手术前后,进行多导睡眠仪(PSG)监测和Epworth嗜睡量表(ESS)评分,比较手术前后睡眠质量、结构、体位和SDS变化。结果 睡眠效率［(86.4±6.4)% ～ (89.4±6.8)%, P＝0.043］、ESS评分(10.08±3.3 ～ 8.1±3.3, P=0.001)和睡眠R期［(15.5±4.0)%～(18.8±4.7)%, P＝0.006］手术后有明显改变。觉醒指数(ArI)、其他睡眠期、侧卧位占睡眠时间比例、呼吸暂停低通气指数(AHI)、最低血氧饱和度(LSaO2)和鼾声术后差异无统计学意义。结论 单纯鼻腔手术可部分改善睡眠质量和结构,但对体位、鼾声和阻塞性睡眠呼吸暂停无影响。     

97例开放性鼻外伤的功能和形态重建

目的探讨开放性鼻外伤的形态和功能重建的手术方法。方法回顾性总结2007年1月～2010年2月97例开放性鼻外伤患者的临床资料,所有病例均行一期清创修复,其中13例伴有鼻骨和上颌骨骨折者同期行骨折复位;15例伴有软组织缺损者行邻近皮瓣修复或游离植皮修复创面;对所有贯穿鼻腔或伴有骨折的病例均行鼻腔填塞和外鼻可塑铝板鼻夹固定,5例术后行鼻腔置管。结果97例患者均一期愈合,鼻面部外观满意,鼻腔功能正常。结论开放性鼻外伤的功能和形态重建中,仔细清创,骨折复位,鼻腔填塞,软组织缝合,必要的前鼻孔置管的正确处理非常重要。     

重度阻塞性睡眠呼吸暂停低通气综合征合并高血压患者血清心肌酶及尿酸水平的变化

目的 探讨重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并高血压患者血清肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)及尿酸(UA)水平的变化,对比分析OSAHS患者心脏功能异常率。方法 选取经多导睡眠监测确诊为重度OSAHS的患者90例,其中67例为单纯OSAHS组,23例为OSAHS合并高血压组,同时选取30例原发性高血压患者为单纯高血压组、20例健康查体人员为对照组,测定四组人群CK、CK-MB、LDH及UA水平,并对两组OSAHS患者心脏结构和功能异常率进行对比分析。结果 与对照组相比,单纯OSAHS组、OSAHS伴高血压组的CK、CK-MB、LDH、SUA明显升高(P<0.05或P<0.01);与单纯OSAHS组相比,OSAHS伴高血压组的CK、LDH、SUA明显升高(P<0.05),但CK-MB差异无统计学意义(P>0.05)。OSAHS伴高血压组左心室向心性肥厚、室间隔增厚、左心房增大、主动脉瓣返流、E/A<1的发生率均明显高于单纯OSAHS组(P<0.05或P<0.01)。相关分析显示,OSAHS患者的CK、LDH、SUA均与AHI呈正相关,且与SpO₂呈负相关(P<0.05或P<0.01);CK-MB与AHI、SpO₂无明显相关(P>0.05)。结论 重度OSAHS患者血清心肌酶及尿酸水平有不同程度的升高,且若合并高血压则尿酸及部分心肌酶升高更明显;重度OSAHS患者的心脏结构和功能有一定的异常率,且合并高血压会明显升高此概率;尿酸及CK、LDH与OSAHS病情严重程度及缺氧程度相关。     

鼻及鼻咽部病变的解除对反复发作分泌性中耳炎的治疗作用

目的探讨鼻及鼻咽部病变的解除对反复发作分泌性中耳炎的治疗效果。方法总结分析1998年1月—2007年5月经治的反复发作的分泌性中耳炎患者38例。其中男20例,女18例;左耳16例,右耳13例,双耳9例,共47耳。26例儿童腺样体肥大和1例成人腺样体肥大行腺样体刮除术;2例后鼻孔息肉行鼻内镜手术切除;6例鼻中隔偏曲伴下鼻甲肥大行鼻中隔矫正术加下鼻甲部分切除术;3例下鼻甲肥大行下鼻甲部分切除术。结果26例（33耳）儿童腺样体肥大者术后随访3～6个月,听力正常,鼓室曲线为A型。成人12例（14耳）各种病变手术后随访6～12个月,听力恢复正常或明显改善,声导抗检查A型曲线10耳,C型曲线4耳。结论反复发作分泌性中耳炎伴有鼻及鼻咽部病变如腺样体肥大、鼻中隔偏曲、下鼻甲肥大、后鼻孔息肉等,应先对这些疾病进行手术治疗,可获得良好的效果。     

功能性鼻整形解剖学基础及进展

鼻整形按照手术目的可以分为美容性鼻整形和功能性鼻整形。功能性鼻整形是通过调整鼻部框架结构来改善鼻子的通气功能,手术过程中,外观也会发生改变。常见的功能性鼻整形病种有歪鼻、尾段鼻中隔偏曲、陈旧性鼻骨骨折、鼻软骨畸形、内外鼻瓣的塌陷和狭窄等。现将对功能性鼻整形的解剖学基础与进展作一综述,以提高对功能性鼻整形的认识。     

鼻面部畸形行功能性鼻整形术中应关注的问题

鼻面部外伤可以造成鼻面部骨结构破坏和软组织结构的畸形,出现形态和功能上的缺陷,功能性鼻整形外科要求在改善外形的同时,恢复鼻功能。本文从功能性鼻整形外科角度就骨性鼻锥、软骨性鼻锥和鼻阀结构畸形中的常见的需关注的问题,作简要地阐述。     

Guidelines for the clinical practice: aesthetic and functional rhinoplasty

A multidisciplinary working group of experts met in 2006 in order to establish a list of recommendations concerning the aesthetic and functional rhinoplasties. These experts tried to answer various practical problems while relying, on one hand, on a critical analysis of the literature, and on the other hand, on a consensus within the group. Six topics were approached. The management of the preoperative consultation, the surgical environment, the contra-indications, the materials used, the management of the post operative period, some particular pathological situations. This collective reflexion thus did not relate to the surgical techniques but to the methodology of treatment of patients who are candidates for rhinoplasty. It comes out clearly from this collective work that surgical indication can only be addressed after having clarified all the technical and psychological aspects. The use of computer graphics is recommended. Cartilage autograft are recommended as a priority.     

A novel intranasal stent for functional rhinoplasty and nostril stenosis

Objectives/Hypothesis: The surgical correction of nostril stenosis and external nasal valve collapse typically involves the addition of tissue to widen and strengthen these areas. However, over the ensuing months, postoperative scar contracture may act to reverse the surgical modifications. This study aimed to determine the safety and efficacy of the use of nasal stents fashioned from a nasopharyngeal airway tube to prevent postoperative contracture at these sites. Study Design: Retrospective review of six patients who underwent functional rhinoplasty with alar batten graft placement for nasal valve collapse and one patient who underwent composite graft repair of unilateral nostril stenosis. Methods: Patients completed a survey inquiring about the ease of use, discomfort, presence of infection, and ability to breathe with these nasal stents. Patients also completed the NOSE (nasal obstruction symptom evaluation) instrument to compare their overall level of preoperative and postoperative nasal breathing. The functional rhinoplasty patients were examined for degree of dynamic airway nasal wall collapse and position of the lateral nasal wall on intranasal examination. Results: Six of seven patients overall reported no to minimal discomfort, easy application, and no to minimal obstruction of nasal breathing with the use of the stents. One patient reported difficulty with application. Preoperative NOSE scores averaged 67.1 (SD 10.4), 18.6 (SD 14.6) at the time of splint removal, and 21.4 (SD 15.2) at 3 months after stent removal. Paired t test analysis showed significant differences between the NOSE scores preoperatively as compared with the time of splint removal (P = .0002) or 3 months after splint removal (P = .0003). All patients demonstrated a significant reduction of lateral nasal wall collapse with inspiration on physical examination. Conclusions: The use of nasal stents made from nasopharyngeal airway tubes is a safe, convenient, and economic treatment for the prevention of contracture after surgical correction of nostril stenosis or nasal valve insufficiency.     

The 'butterfly' graft in functional secondary rhinoplasty

OBJECTIVE: To describe a surgical technique (the conchal cartilage "butterfly" graft) which, when used in properly selected patients, has been found to be a dependable method for alleviation of postrhinoplasty internal nasal valve dysfunction. STUDY DESIGN: Retrospective chart review. METHODS: Analysis of consecutive patients with weakness and/or collapse of the upper lateral cartilages following rhinoplasty. Seventy-two patients (37 women and 35 men, age range 17-76 y) had severe nasal obstruction and were found to have indications for this procedure. All patients had undergone at least one rhinoplastic procedure. All patients were followed for a minimum of 2 years after surgery. RESULTS: All 72 patients experienced significant subjective improvement in relative nasal obstruction. Two patients (3%) reported less than total resolution of their difficulty breathing through their nose; the remaining 70 patients (97%) reported complete resolution of their nasal airway problems. No patients reported their postoperative nasal obstruction as the same or worse than their preoperative baseline. Sixty-two patients (86%) reported improvement in the appearance of their nose, 8 patients (11%) felt that their appearance was unchanged, and 2 patients (3%) felt that the appearance of their nose was made worse by the procedure. CONCLUSIONS: Patients presenting with nasal obstruction after rhinoplasty are frequently found to have collapse and/or weakening of their upper lateral cartilages with resulting nasal valve dysfunction. The conchal cartilage "butterfly" graft is a technique which, when properly performed during revision rhinoplasty, yields predictable functional and cosmetic results with minimal morbidity.     

Patient benefit from functional and cosmetic rhinoplasty

The Glasgow Benefit Inventory, a validated post-interventional questionnaire, was used to determine patient benefit from septorhinoplasty according to indication (function, cosmesis or a combination) in 87 patients. We showed a very significant patient benefit from this procedure and have demonstrated that the benefit is greatest when cosmesis is an indication (P = 0.05).     

Cartilage grafts in functional and aesthetic rhinoplasty

Complications after rhinoplasty could often be prevented if less of the support structures of the nose were resected and cartilage transplants were used to give stability. Long-term complications depend heavily on the nasal anatomy, Which is why the surgeon must be able to identify anatomical variants and adapt the surgical technique as necessary. Thus, rhinoplasty techniques have moved away from excisional methods and shifted toward repositioning and restructuring existing tissues. Conservative reduction and preservation of support structures will maximize the aesthetic and functional results. Checking the shape of the tip of the nose is the critical step, and stabilization of the nasal base in particular leads to a good long-term outcome with preservation of the nasal tip projection. The surgeon needs to stabilize the structure of the nose by building up the structure and must also anticipate the effects of scar contracture. This entails structural grafting with autologous cartilage. In this paper, the authors present the grafting techniques most commonly used to sculpt the nasal framework; in primary and secondary rhinoplasty. Tried and tested grafts are presented, with the appropriate nomenclature relating to each and also the anatomical locations of and clinical indications for each.     

主客观评估在功能性鼻整形术中的应用

目的探讨主客观评估方法在功能性鼻整形术中的应用。方法选择2017年1月至2018年10月在重庆医科大学附属第一医院耳鼻咽喉科接受功能性鼻整形术的患者64例,其中男性32例,女性32例,年龄18~45岁。在术前及术后6个月,分别应用视觉模拟量表(VAS)、鼻阻塞症状评估量表(NOSE)、鼻声反射、鼻阻力检测等评估鼻通气功能,应用VAS、鼻整形结果评估量表(ROE)、外鼻亚单位测量等评估鼻外形情况,应用情感平衡量表及Rosenberg自尊量表评估心理状态,最后行综合满意度分析及各指标间的相关性分析。采用SPSS 23.0软件进行统计学分析。结果与术前相比,术后患者鼻塞VAS、NOSE评分、鼻腔总阻力及鼻腔阻力差异比均显著下降[(1.62±0.85)分比(7.56±1.44)分,(22.62±3.54)分比(69.75±7.85)分,(0.16±0.08)Pa·s/ml比(0.31±0.43)Pa·s/ml,0.33±0.28比0.71±0.32,P值均<0.05];术后患者鼻外形VAS及ROE评分均显著升高[(11.20±3.66)分比(2.70±0.97)分,(17.80±2.71)分比(7.50±1.12)分,P值均<0.05];外鼻亚单位测量示术后鼻背坡长、鼻面角、鼻额角及鼻翼角明显缩小[(29.33±4.26)mm比(33.61±5.24)mm,(135.11±3.81)°比(139.91±6.30)°,(130.63±2.88)°比(136.74±5.72)°,(99.71±4.02)°比(106.27±5.60)°,P值均<0.05];术后情感平衡量表、Rosenberg自尊量表评分明显增高[(5.88±1.54)分比(4.31±1.85)分,(28.31±2.64)分比(22.13±2.77)分,P值均<0.05]。Pearson相关性分析显示,患者满意度与鼻通气主观评分(VAS、NOSE)、鼻外形主观评分(VAS、ROE)、情感平衡量表评分呈正相关,与鼻阻力测值呈负相关,与外鼻亚单位测值无相关性。鼻通气主观评分与鼻阻力测值呈显著正相关,但鼻外形主观评分与外鼻亚单位测值无相关性。结论用主客观结合的方式从鼻通气功能、鼻外观美学、心理状态多角度整体综合评估,可有效评价功能性鼻整形术的疗效。