再次鼻中隔矫正术

目的 探讨鼻中隔矫正术失败而再次手术的技术方法。方法 对1992-2004年鼻中隔矫正术失败的32例患者进行鼻科检查,根据患者鼻中隔偏曲的部位、程度,原有软骨及骨质的残留状况和患者年龄,我们采用3种不同的手术切口（径路）进行矫正：①对5例鼻中隔前端偏曲,1例低位偏曲和14例高位偏曲的患者采用鼻中隔前端“U”形切口;②对8例鼻中隔后端偏曲和2例高位偏曲患者,在偏曲部位的前方作纵向切口,并辅助鼻内镜进行矫正;③对2例鼻中隔前端低位偏曲的青少年患者采用唇龈沟正中横切口,向上揭翻,辅助耳科电钻进行手术。结果 32例患者均获满意矫正,鼻中隔偏曲引起的临床症状消失或明显改善。随访6～36个月,无一例出现鼻中隔穿孔、鞍鼻、鼻腔粘连等并发症。结论 鼻中隔偏曲再次矫正术需针对不同的临床特点选择正确的手术方法,可获满意效果。     

内镜下鼻中隔黏膜下矫正术

鼻中隔黏膜下矫正术是一种符合鼻生理功能的手术,笔者对1995年3月~1999年8月在武汉大学人民医院耳鼻咽喉-头颈外科内镜下行鼻中隔黏膜下矫正术的126例患者进行回顾性分析,现报告如下。1资料与方法1.1临床资料126例患者中,男90例,女36例;年龄12~61岁,其中16岁以下12例,平均38岁。所有患者术前均做鼻内镜检查和鼻窦CT扫描(冠状位加轴位)以了解偏曲的部位和是否伴有鼻窦炎。126例患者中前部偏曲28例,高位偏曲47例,低位偏曲(嵴状突起)26例,后部矩状突起8例,前部偏曲伴后部低位矩状突起12例,高位偏曲伴低位嵴状突起5例。126例中有98例(136侧)伴…     

鼻内窥镜下鼻中隔偏曲再矫正术30例

我科于 1 993年 8月～ 1 999年 3月在鼻内窥镜下行鼻中隔偏曲再矫正术 30例 ,效果十分满意。现报道如下。1　资料与方法1 .1　临床资料30例中 ,男 1 8例 ,女 1 2例 ;年龄 2 1～ 57岁。头痛、鼻根闷胀 1 4例 ,单侧鼻塞 9例 ,反复鼻出血 7例 ,并发变应性鼻炎 5例 ,慢性鼻窦炎、鼻息肉 3例。既往作过鼻中隔粘膜下切除术 2 7例 ,鼻内窥镜下鼻中隔矫正术 3例。检查 :高位偏曲 1 7例 ,嵴突残留 1 0例 ,后部偏曲 3例。将 1 %地卡因加 0 .1 %肾上腺素棉片置于鼻中隔高位偏曲相对中鼻甲的部位后 ,症状明显改善或消失。1 .2　手术方法用 1 %地卡因加 0…     

上颌骨前壁带蒂骨膜瓣修补鼻中隔前部穿孔

临床上鼻中隔较大穿孔修补比较困难。1 995年1月～ 1 998年 3月 ,我们利用上颌骨前壁带蒂骨膜瓣修补鼻中隔前部中等穿孔 5例 ,穿孔全部闭合。报告如下。1　资料与方法5例患者中 ,男 4例 ,女 1例 ;年龄 2 8～ 54岁。2例有不良的挖鼻习惯 ,3例为鼻中隔矫正术后继发性鼻中隔穿孔。均有鼻腔干燥、结痂及反复鼻出血病史。鼻腔检查 :无炎症、肉芽及肿物 ,无全身性慢性疾病。鼻中隔穿孔呈圆形或椭圆形 ,直径 1 .0～1 .5cm。穿孔全部在鼻中隔软骨前部或鼻中隔软骨与梨鼻软骨交界处。术前准备 :术前 1周用生理盐水 50 0 ml加庆大霉素 8万 u冲洗鼻腔 ,…     

鼻内镜下完整保留鼻中隔软骨的鼻中隔矫正术128例临床分析

目的总结鼻内镜下鼻中隔矫正术的方法和完整保留鼻中隔软骨的可行性。方法2009年3月~2012年6月鼻内镜下行较完整保留鼻中隔软骨的鼻中隔矫正术128例,根据偏曲部位不同,选择不同的切口部位。鼻中隔软骨部单纯偏曲和/或上颌骨鼻突偏曲行偏曲侧Killian术式切口,复杂型偏曲均行左侧Killian术式切口,筛骨垂直板C型偏曲、棘突和梨骨嵴或棘突行偏曲前方0.5 cm处切口。术后随访6~12个月。结果 128例鼻中隔偏曲均一次性得以矫正,其中治愈112例（87.5%）,好转16例（12.5%）。所有患者术后双鼻腔通气良好。结论鼻内镜下行鼻中隔矫正术,具有视野清晰、微创、精准等优点,对不同类型鼻中隔偏曲选择个性化切口和术式可完整保留软骨支架、出血量少、并发症少,值得推广应用。     

鼻内镜下鼻中隔修正术

目的探讨鼻中隔矫正术失败而行鼻内镜下鼻中隔修正手术的技术方法。方法对1997年4月~2006年4月鼻中隔矫正术失败的39例患者在鼻内镜下根据患者鼻中隔偏曲的部位、程度、原有软骨及骨质的残留状况采用2种不同的手术径路:①对10例鼻中隔前下端偏曲,1例低位偏曲和14例高位偏曲的患者采用鼻中隔前端"C"形切口。②对12例鼻中隔后端偏曲和2例高位偏曲患者,在偏曲部位的前方作小弧形切口,必要时辅助电钻或骨锉进行手术。结果39例患者均获满意矫正,鼻中隔偏曲引起的临床症状消失或明显改善。随访6~24个月,无1例出现鼻中隔穿孔、鞍鼻、鼻腔粘连等并发症。结论鼻内镜下鼻中隔修正手术针对不同的临床特点选择正确的手术方法,可获满意效果,是一种鼻中隔偏曲矫正术失败进行补救行之有效的方法。     

鼻内镜下鼻中隔偏曲再次矫正术27例临床分析

目的探讨鼻内镜下鼻中隔再次矫正术的方法和要点。方法在鼻内镜下对27例鼻中隔矫正术失败的患者进行再次鼻中隔矫正。结果术后鼻内镜下检查27例患者均获满意矫正,鼻中隔偏曲引起的临床症状消失或明显改善,与术前比较,差异有统计学意义（P〈0.01）。随访0.5～3年,无1例出现鼻中隔穿孔、鞍鼻、鼻腔粘连等并发症。结论手术前全面评估、确立重点矫正部位及术式,鼻内镜下鼻中隔再次矫正术可获得满意效果。     

鼻内镜下鼻中隔矫正术169例

目的：探讨鼻内镜下鼻中隔矫正术的优点及适应证。方法：在鼻内镜下行鼻中隔矫正术169例，其中单纯鼻中隔偏曲112例，合并有鼻息肉、鼻窦炎57例，术后填塞用内装蓬松海绵的一次性硅胶套。结果：169例中术后随访3-6个月者157例，治愈146例（92.99％，146/157），好转11例（7.01％，11/157），无无效者。无一例发生发生鼻中隔穿孔、血肿等并发症。结论：鼻内镜下鼻中隔矫正术具有操作精细、损伤小、切口无需缝合等特点；对合并有鼻息肉、鼻窦炎者可行同期手术，节省时间及费用；改良鼻腔填塞物，在很大程度上减轻了病人痛苦。     

显微镜下鼻中隔矫正术

鼻中隔偏曲类型多样,程度不一,多采用鼻中隔粘膜下矫正术治疗。我科于2001年～2003年采用显微镜下鼻中隔矫正术治疗鼻中隔偏曲78例,取得了较满意效果,现报告如下。1 资料与方法 本组78例,男57例,女21例;年龄16～56岁。其中鼻中隔偏曲伴过敏性鼻炎19例,慢性鼻窦炎伴鼻中隔偏曲32例,鼻中隔偏曲伴发鼻出血3例,鼻源性头痛伴发鼻中隔偏曲7例,单纯鼻中隔偏曲17例。方法:手术采用Leika M-400E型手术显微镜,术者站     

连体鼻中隔骨支架矫治鼻中隔偏曲

笔者自1985年10月～1995年10月吸取鼻中隔成形术的优点，采用连体鼻中隔骨支架粘膜下矫正鼻中隔们抽132例。体会到这一改良型手术操作简单，损伤小，既有效地避免了鼻中隔穿孔的发生，又尽可能地保全了鼻中隔的支架功能，效果满意。1资料与方法1．1临床资料接受鼻中隔矫正术的132例中，男103例，女29例；年龄18～46（平均31）岁。其中以鼻中隔软骨偏曲为主者53例，以筛骨垂直板偏曲为主者31例，鼻中隔软骨与筛骨垂直板均偏曲者48例。1．2手术方法麻醉、切口及分离两侧鼻中隔面软组织与Kil-lian手术相似，但切口应尽可能靠近鼻中隔软骨之前…     

Endoscopic Repairment of Septal Perforation with Using a Unilateral Nasal Mucosal Flap

Objectives

Nasal septal perforation is an anatomic defect of the cartilaginous and bone tissues of the nasal septum. Many approaches and techniques to repair nasal septal perforations have been reported on. The purpose of this paper is to report on our surgical technique and the results of the treatment for nasal septal perforations.

Methods

From May 2001 to March 2008, 14 patients (12 males and 2 females; mean age: 41.3 yr) were enrolled. The mean perforation size was 15 mm, and all the perforations were located at the cartilaginous portion. Our surgical technique is based on an endoscope-assisted endonasal approach, with dissection of unilateral advanced mucosal flaps with using a temporalis fascia graft. The follow-up periods ranged from 3 to 23 months (mean follow-up period: 8 months).

Results

Using our surgical technique on 14 patients, 12 cases (85.7%) of septal perforation were closed without complication. The remaining two patients (14.3%) had incomplete closures (about 2-3 mm) without any significant symptoms related to the remaining perforation.

Conclusion

Our technique is a viable procedure with a high success rate for achieving closure of nasal septal perforations. It has the advantages of shortening the operative time, no external incision and avoiding any other perforation during the operation. Therefore, we consider it to be a good alternative for repairing nasal septal perforations.     

A clinical treatise upon the nasal septal perforation]

Thirty nine cases of septal perforation of various origins were presented using clinical such as backgrounds age, gender, possible causes, and size of septal perforation evaluated by diameter. The cases included 26 males and 13 females with a mean age of 35 years range: 8 to 85 years. Possible causative factors were as follows: septal surgeries (9), other nasal and paranasal surgeries (17), nasal cautery or tamponade (2), occupational (2), collagen disease (2), inflammatory (1) and idiopathic (5). Signs and symptoms related to perforations were minor, such as stuffy nose (3), running nose (3), nosebleed (5), dry sensation (4), nasal pain (1), and asymptomatic (23). Sizes of perforations by largest diameter were small (less than 10 mm) in 7, moderate (11-20 mm) in 13, and large (more than 21 mm) in 6. The size of perforations tended to be variable, but two cases with collagen disease showed large perforations 35 mm. Although iatrogenic and idiopathic cases comprised the majority of cases (80%), such a few cases of grave significases as collagen and hematological diseases showed unusually large perforations.     

异种脱细胞真皮基质修复鼻中隔穿孔的临床分析

目的探讨异种脱细胞真皮基质（heterogeneous aeellular dermal matrix,HADM）修复鼻中隔穿孔的临床效果。方法选择9例鼻中隔穿孔患者应用异种脱细胞真皮基质口腔修复膜进行修复,术后进行随访,观察生物膜成活情况及其对患者的影响。结果9例鼻中隔穿孔患者均一次性修复成功,双侧鼻腔通气良好,鼻部症状完全消失。随访1～3年,鼻中隔未见穿孔,受植床表面颜色多为粉红,质地柔软,轻微瘢痕,均未出现局部或全身反应。结论异种脱细胞真皮基质口腔修复膜作为自体皮瓣的替代品,用于鼻中隔穿孔修复效果满意。     

Nasal septal cyst: a rare phenomenon

Introduction

Well-recognized complications of nasal septal surgery i.e. septoplasty or submucous resection (SMR), include septal haematoma, infection, septal perforation and external nasal deformity. Nasal septal cysts are extremely rare in rhinology.

Objectives

To discuss the underlying aetiological theories, management and strategies for prevention of this very rare complication of a commonly performed rhinological procedure such as SMR.

Case report

We describe a case of a nasal septal cyst several years after an SMR had been performed, which was excised using an open rhinoplasty approach that has not previously been described for this purpose.

Conclusion

Entrapment of free nasal mucosal remnants or inward folding of incised septal mucosa in the submucosal space is postulated as the cause of this phenomenon, leading to the development of this type of “inclusion” cyst. Postoperative nasal packing, especially if traumatic, may exacerbate this. We recommend that anterior nasal packing should be used only if necessary, and packs inserted with care, possibly under endoscopic guidance.     

Anterior palate sensory impairment after septal surgery

BACKGROUND: This study was performed to present a series of patients who experienced anterior palatal sensory impairment after nasal septal surgery. This phenomenon has not been reported in the English literature to date. METHODS: We reviewed 107 septal surgeries done by the same surgeon over a 3-year period. One hundred one surgeries were septoplasty by technique of submucous resection, three surgeries were septal perforation repairs using a mucosal advancement flap from the nasal floor, two surgeries were excisions of benign septal neoplasms, and one surgery was a closed reduction of a nasal septal fracture. RESULTS: Overall, 3/107 patients (2.8%) experienced postoperative numbness of the anterior palate. Two of these patients underwent septoplasty, and the third patients underwent repair of septal perforation. A chisel was used to resect a portion of the maxillary crest posterior to the nasal spine in 11 patients, including the 3 patients who reported postoperative numbness. Suction cautery was also used in one of the 3 patients to address bleeding of the nasopalatine artery. Two patients reported concomitant palatal paresthesias with numbness, and both had recovery of normal sensation at 3 months follow-up. The third patient, in whom cautery was used, continued to experience numbness 1 year postoperatively. CONCLUSION: Sensory impairment of the anterior palate may result from surgery of the nasal septum and appears to be associated with chisel of the maxillary crest. Cautery should be avoided near the nasopalatine foramen. The relevant surgical anatomy of the nasopalatine nerve is reviewed and discussed in the context of these cases.     

Anmerkungen zur Septumplastik

There is a discrepancy between the occasionally heard opinion that septoplasty is an easy operation and its relatively high failure and complication rates. Here we discuss the specific difficulties and possible pitfalls of functional reconstructive septoplasty. The significance of optimal vision using a binocular operating microscope is emphasized. Most of the important measures needed to avoid postoperative complications such as redeviation, pseudo-hump nose or nasoseptal defect are painstaking subperichondrial dissection without injuring the septal cartilage, use of the so-called Cottle-tunnels, sufficient mobilisation and exact straightening of the anterior septal cartilage without remaining tension, stable reconstruction of the posterior septum with cartilaginous and/or bony fragments after selective resection of deviated septal parts, re-fixation of the mobilized anterior cartilage (“swinging-door”) to the periosteum of the anterior nasal spine and, perhaps, primary suture of iatrogenic perforations of the mucoperichondrium during the operation. If postoperative complications such as septal hematoma, septal perforation or saddling of the nose are recognized during the first postoperative week, immediate revision surgery is recommended.     

Comments on septoplasty

There is a discrepancy between the occasionally heard opinion that septoplasty is an easy operation and its relatively high failure and complication rates. Here we discuss the specific difficulties and possible pitfalls of functional reconstructive septoplasty. The significance of optimal vision using a binocular operating microscope is emphasized. Most of the important measures needed to avoid postoperative complications such as redeviation, pseudo-hump nose or nasoseptal defect are painstaking subperichondrial dissection without injuring the septal cartilage, use of the so-called Cottle-tunnels, sufficient mobilisation and exact straightening of the anterior septal cartilage without remaining tension, stable reconstruction of the posterior septum with cartilaginous and/or bony fragments after selective resection of deviated septal parts, re-fixation of the mobilized anterior cartilage ("swinging-door") to the periosteum of the anterior nasal spine and, perhaps, primary suture of iatrogenic perforations of the mucoperichondrium during the operation. If postoperative complications such as septal hematoma, septal perforation or saddling of the nose are recognized during the first postoperative week, immediate revision surgery is recommended.     

Septal perforations closure utilizing the backwards extraction-reposition technique of the quadrangular cartilage

Nasal septal perforations are anatomical defects of the nasal septum, causing dynamic alterations in nasal physiology which may lead to variable symptoms and otolaryngological referral. Repair of nasal septal perforations continues to remain a difficult surgical problem, and nowadays there is no definitive solution for their successful surgical closure. Thirty patients with small- or medium-sized anterior nasal septal perforations were treated with a simple technique of backwards extraction-reposition of the quadrangular cartilage. Prior nasal septal surgery and repeated cautery were the most common cause of perforation. After a minimum follow-up of two years the success rate for relief of symptoms and closure of the perforation was 87 per cent. This technique showed very good results in small-sized and selected cases with medium-sized perforations, but the mucosal dissection employed is not suitable for medium to large perforations.     

鼻内镜下应用脱细胞真皮基质及鼻底黏膜瓣修补鼻中隔穿孔

目的 探讨鼻内镜下应用人异体脱细胞真皮基质联合带蒂的鼻底黏膜瓣修补鼻中隔穿孔的可行性和疗效.方法 2006年2月至2010年10月共12例鼻中隔穿孔患者,临床主要表现为鼻塞及穿孔周边结痂.12例中8例为医源性.12例患者鼻中隔穿孔均位于鼻中隔前中部,穿孔直径约1.0～2.3 cm.鼻内镜下在穿孔前缘下部纵向切开残存鼻中隔黏骨膜至鼻底,并沿鼻底横行外延至鼻腔外侧壁.在穿孔后缘后方约1.5 cm处切开鼻中隔黏骨膜至鼻底,并沿鼻底横行外延至鼻腔外侧壁.切开下鼻道处的鼻腔外侧壁黏骨膜,将上述二切口连通.沿上述切口剥离,形成蒂在鼻中隔的鼻底黏骨膜瓣,向前上旋转覆盖穿孔,与穿孔前方和上方边缘黏骨膜间断对位缝合.将脱细胞真皮基质补片贴附于右侧鼻腔穿孔处,基底膜面朝向鼻腔侧,与穿孔边缘黏骨膜间断对位缝合.结果 术后1周见脱细胞真皮基质补片及黏膜瓣与穿孔创缘愈合好,补片未见排斥反应和挛缩.鼻中隔黏膜在4周后基本上皮化.随访3个月至4年,11例修补成功,1例失败.未见手术并发症.结论 联合应用人异体脱细胞真皮基质和带蒂的鼻底黏骨膜瓣修补鼻中隔穿孔,手术方法简便,手术成功率高,是一种修补鼻中隔穿孔的有效方法.

Abstract：

Objective To introduce the method and evaluate the efficacy of endoscopic repair of nasal septal perforation with acellular dermal matrix and pedicled mucoperichondrial flap. Methods Twelve patients with perforation of nasal septum were encountered since February 2006 to October 2010. The most common symptoms and sings were nasal obstruction and crusting at the margin of the perforation. Eight of 12 patients were iatrogenic following surgery. The perforation typically located at anterior medial part of the nasal septum, with their sizes ranged approximately 1. 0 -2. 3 cm in diameter. The incision was made at the anterior edge of the perforation from the left nasal cavity and continued to the nasal floor horizontally. It ended at the lateral nasal cavity. Then, another incision was made parallel to the first one, which was 1.5 cm from the posterior of the perforation. The two incisions was connected. The mucoperichondrium was stripped along with the incisions and the pedicle of mucoperichondrial flap kept on the nasal septum. Then,the flap was turned up to cover the perforation and fixed with apposition suture. Put the acellular dermal matrix graft on the perforation from the right nasal cavity and fixed it with apposition suture. Results The healing of the acellular dermal matrix and mucoperichondrium was good in the first week postoperatively and there was no rejective reaction and contracture. The epithelization of the nasal septal perforation finished 4 weeks after surgery. Follow-up ranged from 3 months to 4 years. Eleven patients had successful outcomes with complete closure of their perforations. One patient failed the operation. All of them had no complications. Conclusions Using acellular dermal matrix graft and mucoperichondrial flap to repair the septal perforation is a simple method and the success rate is high. Therefore, it is an effective way to repair the perforation of nasal septum.     

鼻内镜下鼻中隔穿孔修补术

目的探讨经鼻内镜下鼻中隔穿孔修补术影响手术成功率的相关因素。方法23例外伤或手术后鼻中隔穿孔患者采用经鼻内镜下穿孔修补术，术中分别采用筛骨垂直板或颞肌筋膜直接封闭穿孔、翻转黏膜瓣及赝复物夹衬并转移黏膜瓣封闭、下鼻甲带蒂黏膜瓣修补等方法进行修复，并采用硅胶板或塑料膜的保湿物垫衬保护为特点的填塞方式。结果直接封闭7例，翻转封闭5例，转移封闭10例，鼻甲封闭1例。随访4周至7个月，23例鼻中隔穿孔手术修补成功19例（82、6％），4例未成功的病例分别为术后3周黏膜瓣脱落1例、术前存在2个穿孔仅将大穿孔修补成功1例、术后筋膜干燥导致再穿孔1例及转移黏膜瓣太小，穿孔未完全修补成功1例。结论鼻内镜手术是目前修补鼻中隔穿孔的最佳选择之一。