鼻再造术中衬里组织的修复方法

目的探讨鼻再造术中衬里组织的修复方法。方法根据局部组织条件,应用局部翻转皮瓣、口腔黏膜瓣、鼻唇沟皮瓣和预构皮瓣等方法,对24例鼻缺损患者的鼻衬里进行了修复,并转移额部皮瓣和移植自体肋软骨行鼻再造术。术后通过6-34个月的随访,以了解鼻腔衬里组织的情况,如挛缩、破溃等,评价各方法的疗效。结果本组17例采用局部翻转皮肤、瘢痕作为鼻腔衬里,1例采用口腔黏膜瓣,5例采用局部皮瓣,1例采用预构皮瓣重建衬里。再造鼻额部皮瓣及衬里皮瓣均存活,外形逼真,仅瘢痕瓣通气不良。结论在鼻再造术中,正确评估鼻部缺损范围、程度及鼻周残留组织量,选择适当的衬里修复手术方案,可收到良好的手术效果。预构皮瓣可以很好地修复复杂鼻缺损的衬里。     

A nasal shaver for nasal surgery

Provision of a nasal field in nasal surgery is hampered by nasal hairs. We recommend the Remington NE4 nasal shaver as a quick, painless, safe, inexpensive method of nasal hair removal, providing a user-friendly surgical field.     

鼻背皮瓣修复鼻尖缺损的探讨

目的 探讨应用鼻背皮瓣修复鼻尖区组织缺损的方法和效果.方法 根据患者鼻缺损的部位及范围设计鼻背皮瓣,旋转前徙覆盖创面再造鼻尖,修复过程中注意保护各美学单元的完整性,利用天然皱褶掩盖瘢痕.结果 本组4例患者鼻背皮瓣均完全成活,术后随访1～4年,鼻外形良好,效果满意.结论 鼻背皮瓣对于鼻尖1.5～2.5cm的缺损能够提供色泽、质地匹配的修复.     

The use of proximal nasal tissue in nasal reconstruction

Lesions and defects of the nasal tip and alar rim can be reconstructed using composite or full thickness grafts from the proximal alar crease region. The texture, surface effect, and color match much better than the conventional skin grafts from other body areas. The donor site is well hidden in the natural crease of the alar rim and the scars have always been acceptable. This method has been used in ten patients to date and the average dimensions of the grafts are 1.5 x .7 cm.     

Efficacy of external nasal nerve block following nasal surgery

Background

Pain is the major determinant factor which affects the quality of recovery and postoperative agitation following nasal surgery with the patient under general anesthesia. Our objectives were to test the hypothesis that an external nasal nerve block will decrease pain intensity, decrease drug consumption, decrease the incidence of postoperative emergence agitation and improve quality of recovery.

Material and methods

In this study 100 adult patients who were scheduled for elective external nasal surgery with the patient under general anesthesia and nasal packing on each side, received external nasal nerve blocks postoperatively for 24?h with saline (group I) or 2% xylocaine (group II) with 1:200,000 epinephrine. Postoperative pain was measured at the postanesthesia care unit (PACU) utilizing a visual analog scale (VAS). Narcotics consumption was also measured. Emergence agitation and quality of recovery were also assessed.

Results

Pain scores were statistically significant between both groups. Requirements of equivalent morphine doses in the PACU were lower in group II (block) than group I (control) with a significant P value <0.001. Group II (block) patients required significantly less intraoperative fentanyl than group I (control) patients (p?=?0.001). Group II (block) showed higher scores in pain dimension of QoR-40 in comparison with group I (P <0.001). The incidence of emergence agitation was lower in group II (block) than in group I (control, 24% vs. 48%, P?=?0.012).

Conclusion

External nasal nerve block is an effective technique for reducing postoperative pain, drug consumption and quality of recovery. It also reduces emergence agitation. The effects are mainly due to profound analgesia and effective pain control that lead to decreased drug usage and reduced discomfort.

     

鼻中隔软骨在鼻尖整形中的应用

目的：探讨在鼻尖圆钝或低平整形中应用鼻中隔软骨的手术方法及效果。方法：本组35例患者均采用“开放式”切口。根据鼻尖情况,修剪过多软组织,切取鼻中隔软骨,构建鼻尖及鼻小柱软骨支架,以重塑鼻尖形态。结果：自2005年以来,用上述方法整复35例患者,经6个月～2年随访,除6例单纯行鼻尖圆钝整形的患者感鼻尖较低外,其余29例均感满意,效果稳定。结论：在鼻尖圆钝或低平整形中应用鼻中隔软骨可取得良好效果。     

Anterior nasal stenosis secondary to accessory nasal bones

Choanal atresia may result from a posterior or anterior obstruction of the airway. Treatment is predicated on an accurate identification of the underlying pathological condition by means of physical examination, fluoroscopy, and computed tomographic scan. Expeditious surgical management after appropriate diagnosis appears to result in effective relief of the obstruction.     

鼻翼沟切口矫正鼻翼下垂

目的:介绍一种新的矫正鼻翼下垂的手术方法。方法:设计鼻翼沟切口,并在切口上缘做一等腰三角形切除区。游离鼻翼复合体,提升鼻翼,使鼻翼基底高于鼻小柱,使鼻尖和鼻小柱前突,矫正下垂的鼻翼畸形。结果:从2002年以来,临床应用本方法矫正鼻翼下垂患者10例,术后切口愈合好,随访6月～2年,切口无明显瘢痕增生,鼻外形均获满意效果。结论:鼻翼沟切口上提鼻翼下点矫正鼻翼下垂手术简单、术后效果明显、术后瘢痕不明显。     

鼻翼及鼻尖肥大的美容整复

目的:探讨矫正鼻翼鼻尖肥大的最佳手术方法。方法:依鼻翼、鼻尖肥大的特点,采取横向缩小鼻翼法,并注重鼻翼外侧脚的移位。鼻尖整形行开放式手术入路,重塑鼻翼软骨,并把切除下的鼻翼组织块去表皮后置到鼻假体上。结果:30例鼻翼鼻尖肥大患者均取得了良好的手术效果。结论:鼻翼、鼻尖肥大要整体诊治,才能取得良好的手术效果。     

鼻背缩窄截骨术的研究进展

随着人们对美容的要求越来越高,临床整形外科学对外鼻的整形术在逐年增加,外鼻的解剖学结构也越来越受到人们的重视。以往国内、外有关头面部研究资料对外鼻的根部、鼻尖和鼻翼的形态研究较全面,但很少述及鼻背的情况。鼻背骨性宽是外鼻宽大畸形的主要基础,做上颌骨鼻突截骨术可以取得外鼻挺拔秀美的效果。本文就鼻背缩窄截骨整形术的研究进展综述如下。     

基于鼻部美学亚单位鼻翼缺损修复术式的选择

目的参照鼻部美学亚单位的原则,根据鼻翼缺损的大小和毗邻亚单位的缺损,选择鼻翼缺损的修复术式。方法自2011年7月至2013年6月,我们共收治6例鼻翼缺损的患者。其中鼻翼亚单位缺损4例,行耳郭复合组织游离移植;鼻翼合并鼻尖亚单位缺损2例,应用显微外科技术,行逆行颞浅血管供血的耳前皮瓣游离移植,血管蒂与受区邻近的鼻唇沟处角动、静脉吻合。结果本组6例游离组织均成活,随访6～12个月,重建的鼻翼皮肤色泽与周边接近,弹性正常,瘢痕隐蔽。结论大于鼻翼亚单位50％的缺损,用耳郭复合组织游离移植修复;鼻翼合并鼻尖亚单位的缺损,用吻合血管的逆行游离耳前皮瓣修复。     

Effect of nasal valve area on inspirator nasal sound spectra.

OBJECTIVE: We have researched the effects of nasal valve area on the inspiratory nasal sound spectra in this study. STUDY DESIGN AND SETTING: We have spectral analyzed and recorded the inspiratory nasal sound in 22 healthy people with and without the Cottle maneuver. RESULTS: We have found an increase in sound intensity at high frequency in the sound analyses of the subjects without the Cottle maneuver; whereas, a decrease in sound intensity at high frequency was found in subjects with the Cottle maneuver. CONCLUSIONS: The nasal valve area plays an important role in the transformation of the nasal airflow from a laminar pattern to a more turbulent one. This condition affects nasal sound spectra and produces a marked shift upward in frequencies in the spectra. This method may be a new way of evaluating the nasal valve area. EBM rating: C-4.     

氧气鼻导管在鼻胆管固定中的应用

目的探讨氧气鼻导管在鼻胆管引流术(ENBD)鼻胆管固定中应用的效果。方法将42例ERCP患者随机分为观察组与对照组各21例。对照组采用传统法固定,观察组采用氧气鼻导管Y型双螺旋固定法。结果两组均无一例发生脱管;两组鼻黏膜出血发生率、患者舒适度、皮肤美观度比较,差异有统计学意义(P<0.05、P<0.01)。结论氧气鼻导管在鼻胆管中的应用,极大程度地减少了患者痛苦,增加了患者舒适度。