歪鼻矫正术102例临床疗效分析

目的:探讨歪鼻矫正鼻功能重建的手术效果.方法:102例歪鼻患者全部采用鼻内进路.行鼻中隔"摇门"术矫正软骨性歪鼻32例,行骨鼻锥松动、重塑术矫正骨性歪鼻和鼻软骨混合性歪鼻53例,骨鼻锥楔形切除矫正严重骨鼻锥不对称性歪鼻3例,削低或垫高骨鼻锥矫正不规则性歪鼻14例.结果:随访6～48个月(平均20个月),歪鼻矫正良好92例,满意率为92.2%.结论:鼻内进路、多种技术应用矫正歪鼻畸形重建鼻功能,可获得美容和鼻功能改善的双重效果.术中矫正鼻中隔、彻底松解畸形部位的组织及矫正后的内外固定是保证手术成功的关键.     

鼻内进路歪鼻-鼻中隔矫正术

目的 探讨歪鼻-鼻中隔矫正的手术治疗效果。方法60例病人中22例行鼻中隔矫正术;14例行骨部歪鼻矫正术;24例行骨部、软骨部歪鼻矫正术(其中歪鼻合并鞍鼻矫正术8例,合并驼峰鼻矫正术3例)。结果 经随访6～24个月,60例病人中,歪鼻矫正良好54例(满意率90.0％)。结论 鼻内进路歪鼻-鼻中隔矫正术,适应症广泛、操作方便、效果满意、并发症少。术中矫正鼻中隔、彻底松解畸形部位的组织及矫正后的内外固定是保证手术成功的关键。     

鼻中隔骨折对鼻骨骨折复位效果的影响

目的　探讨鼻中隔骨折的发生率及其对鼻骨骨折复位效果的影响。方法　回顾性分析212例鼻外伤患者的临床资料,A组112例行单纯鼻骨闭合复位术,其余患者行同期鼻中隔矫正术;B组58例术前诊断伴有鼻中隔骨折;C组42例诊断单纯鼻骨骨折,比较组间复位效果及手术前后鼻中隔骨折诊断符合程度。结果　A组术后3个月随访发现歪鼻27例（24.1%）,B+C组术后3个月随访共发生歪鼻9例（9.0%）;B组58例（100%）、C组30例（71.8%）患者在术中被证实为鼻中隔骨折,CT诊断鼻中隔骨折符合率为58.0%,而实际鼻中隔骨折发生率为88.0%。结论　CT诊断鼻中隔骨折与实际发生率有明显差异,鼻骨闭合复位术同期行鼻内镜下鼻中隔偏曲矫正术能显著降低术后歪鼻发生率。     

鼻内进路歪鼻-鼻中隔矫正术

目的探讨歪鼻-鼻中隔矫正的手术治疗效果。方法60例病人中22例行鼻中隔矫正术；14例行骨部歪鼻矫正术：24例行骨部、软骨部歪鼻矫正术(其中歪鼻合并鞍鼻矫正术8例，合并驼峰鼻矫正术3例)。结果经随访6～24个月，60例病人中，歪鼻矫正良好54例(满意率90．0％)。结论鼻内进路歪鼻-鼻中隔矫正术，适应症广泛、操作方便、效果满意、并发症少。术中矫正鼻中隔、彻底松解畸形部位的组织及矫正后的内外固定是保证手术成功的关键。     

鼻内镜下自体软骨鼻整形同期鼻中隔偏曲矫正治疗外伤性歪鼻畸形的临床分析

目的对鼻内镜下自体软骨（鼻中隔软骨、耳软骨和肋软骨）鼻整形同期行鼻中隔偏曲矫正治疗外伤性歪鼻畸形的临床分析。方法收集2017~2018年20 例陈旧外伤性歪鼻畸形患者的临床资料,所有患者均行全麻下鼻小柱倒“V”型切口暴露松解并切除偏曲的鼻中隔软骨及骨质,针对不同患者设计使用不同软骨（鼻中隔软骨、耳软骨和肋软骨）矫正鼻中隔骨性或软骨性支架,对鼻尖、鼻背及外鼻重新塑形。结果随访3~12个月,行鼻内镜下自体软骨鼻整形同期鼻中隔偏曲矫正术的患者鼻外形及通气均有明显改善,手术效果更好,无鼻腔粘连、鼻中隔血肿及穿孔。结论鼻内镜下自体软骨鼻整形同期鼻中隔偏曲矫正治疗外伤性歪鼻畸形同期解决了鼻部畸形和鼻通气功能,实现了美容和功能的统一,同时减少了手术治疗的次数和费用,可行性高。     

鼻小柱入路歪鼻矫正术

鼻小柱入路歪鼻矫正术谷京城１孙连玉１刑巍巍１陈秀芝１歪鼻的形成主要是先天性鼻的骨性支架生长过度和外伤所致的鼻的支架偏位，其中鼻中隔骨板起着真正十分重要的作用。矫正歪鼻关键的一步就是矫正鼻中隔的偏曲、增厚和鼻中隔软骨与筛骨、犁骨及硬腭嵴突接合部的异常。...     

鼻整形术:歪鼻整形

歪鼻整形的内容涵盖了鼻的美学及功能。鼻上1/3偏曲的矫正多使用截骨术,鼻中间1/3偏曲通常使用鼻中隔矫正术修复。刻痕、切除、撑开移植物、自体组织撑开瓣等方法被用于矫正鼻背。鼻中隔尾侧偏曲通过刻痕、切除和在鼻前棘上重置鼻中隔来治疗。不同的截骨术用于不同类型的歪鼻畸形。治疗下鼻甲肥大和内鼻阈塌陷是纠正歪鼻气道功能受损的关键。鼻小柱支撑移植物、鼻尖缝合技术和鼻翼基底切除术用于修饰鼻尖和鼻翼。     

歪鼻并鼻中隔偏曲联合整形268例

目的:探讨歪鼻并鼻中隔偏曲同期整形手术的可行性,改进手术方法.方法:设计横鼻小柱基底部至两侧鼻翼缘中部的蝶形切口,掀起鼻下端皮瓣,显示鼻中隔、隔背软骨和鼻骨.手术中拱顶石区的分离、固定是歪鼻整形的关键;鼻中隔软骨与筛骨垂直板和上颌骨鼻嵴分离、整形是鼻中隔整形的关键;两侧鼻腔放入等量凡士林纱条或膨胀海绵,起到鼻腔内固定和防止鼻中隔血肿作用;24 h后分上、下午取出堵塞物,能减轻鼻腔填塞痛苦;鼻外固定作用不大,可省略不做.结果:本组268例,经6～24个月随访,满意228例,基本满意40例.结论:歪鼻并鼻中隔偏曲联合整形术,解决了歪鼻的美容问题和鼻中隔偏曲矫正后鼻功能重建的问题.     

鼻外进路治疗鼻中隔高位及后段偏曲

目的探索安全有效矫正鼻中隔高位及后段偏曲的手术方法。方法采用鼻外进路,保留鼻中隔软骨,矫正鼻中隔偏曲。结果1992年1月～2002年1月共治疗鼻中隔高位偏曲55例,术后随访6月～1年,鼻塞症状缓解42例,头痛症状缓解27例,嗅觉恢复12例;3例鞍鼻、16例歪鼻畸形者矫正满意,5例歪鼻半年后复发。该方法具有视野大,操作方便,不会引起鼻梁下塌等优点,可安全、彻底地矫正鼻中隔高位及后段偏曲。结论鼻外进路治疗鼻中隔高位及后段偏曲比传统的鼻中隔矫正术更安全有效,并可同时矫正外鼻畸形。     

鼻内镜下整复陈旧性鼻骨骨折所致歪鼻畸形1例

患者男性,33岁,10年前因鼻外伤而致左鼻骨骨折,当时因故未及时就诊而致外鼻畸形并通气功能受影响。于2001年12月13日来诊。检查:鼻背略右偏,左侧塌陷,中隔呈“C”形右偏。鼻骨CT显示:鼻骨呈陈旧骨折征象,左侧下陷,鼻背向右偏,鼻中隔明显右凸侧弯。诊为“陈旧性鼻骨骨折所致歪鼻畸形,中隔偏曲”。于2001年12月16日在全麻下行鼻内镜下中     

鼻-鼻中隔整形术治疗部分外伤性歪鼻畸形

目的 探索外伤性歪鼻畸形新的临床分类和标记方法,应用鼻-鼻中隔整形术治疗部分外伤性歪鼻畸形。方法 选择外伤性歪鼻畸形患者26例,其中C型5例、O型12例和S型9例。分别在术前测量其偏离值,经七步法手术治疗,术后进行随访。结果 17例C型、O型歪鼻畸形患者术前偏离值为(5.50±2.08)mm,术后为(2.12±1.11)mm,经配对t检验,差异有显著意义(t=6.9031,P=0.0001)。17例C型、O型歪鼻畸形临床治愈率为58.8％、有效率为88.2％。9例S型歪鼻畸形因有2个偏离值暂未进行统计。结论 新的临床分类和标记方法适用于外伤性歪鼻畸形的临床研究,鼻-鼻中隔整形术是一种治疗外伤性歪鼻畸形很有效的治疗术式。     

伴慢性鼻及鼻窦炎的外伤性歪鼻畸形一期鼻功能性整复

目的探讨伴慢性鼻及鼻窦炎的外伤性歪鼻畸形一期鼻功能性整复的可能性、手术方法、术后疗效及手术并发症。方法选择37例伴慢性鼻及鼻窦炎的外伤性歪鼻畸形患者,一期行鼻中隔矫正、功能性鼻内镜手术、鼻甲手术、歪鼻矫正等。术后1个月随访观察外鼻形状,并测量术后偏离值。术后3个月对慢性鼻及鼻窦炎症状行主观评分和内镜下评分,评分结果行统计学处理。结果37例歪鼻患者,术前偏离值为（6.64±2.21）mm,术后偏离值为（2.04±0.97）mm,手术前、后偏离值差别有显著性意义（t=6.374,P〈0.001）,其中歪鼻治愈率83.8%（31/37）、有效率16.2%（6/37）。慢性鼻及鼻窦炎治愈率为95.4%,手术前、后急性鼻窦炎复发、嗅觉、鼻腔通气、鼻腔分泌物、头痛、总体症状改善6项评分经t检验,差异均有统计学意义。结论伴慢性鼻及鼻窦炎的外伤性歪鼻畸形一期鼻功能性整复,一次手术同时完成鼻功能重建及外形矫正,符合现代鼻外科学发展要求,具有推广价值。     

鼻-鼻中隔整形术治疗部分外伤性歪鼻畸形

OBJECTIVE: To explore the new classification and marking method for traumatic deviated nose treated by septo-rhinoplasty. METHODS: Twenty-six selected cases of traumatic deviated nose were analysed. There were 5 C-type cases, 12 O-type cases and 9 S-type cases. Deviated parameters were measured before and after operation. All patients were treated by seven-step method. RESULTS: Clinical data in seventeen patients including C-type and O-type were complete. There was significant difference in changes of deviated parameters before and after operation( t = 6.9031, P = 0.0001). The cure rate was 58.8%, the effective rate was 88.2%. CONCLUSIONS: The new clinical classification and marking method for traumatic deviated nose are suitable for clinical study. Septo-rhinoplasty is effective for traumatic deviated nose.     

Die Schiefnase

The deviated nose represents a complex cosmetic and functional problem. Septal surgery plays a central role in the successful management of the externally deviated nose. This study included 800 patients seeking rhinoplasty to correct external nasal deviations; 71% of these suffered from variable degrees of nasal obstruction. Septal surgery was necessary in 736 (92%) patients, not only to improve breathing, but also to achieve a straight, symmetric external nose. A graduated surgical approach was adopted to allow correction of the dorsal and caudal deviations of the nasal septum without weakening its structural support to the nasal dorsum or nasal tip. The approach depended on full mobilization of deviated cartilage, followed by straightening of the cartilage and its fixation in the corrected position by using bony splinting grafts through an external rhinoplasty approach.     

A review of practical guidelines for correction of the deviated, asymmetric nose

Repair of the twisted nose presents a challenge, as often functional problems as well as aesthetic deformities must be addressed. Traditional correction of the deviated nose involves septal correction, separation of both upper lateral cartilages from the septum and bony pyramid manipulation after osteotomies. Nowadays autogenous cartilage grafts are being used for repositioning, reinforcement, recontouring and reconstruction of virtually every component of the nasal skeleton. These restructuring techniques follow the modern principles mentioned above and may well be applied to the deviated asymmetric nose. The grafting manoeuvres increase the stability of the realigned cartilaginous nasal framework, including the nasal septum, but may also be used for camouflaging purposes. The large number of possible individual anatomic variations including facial asymmetry does call for a systematic approach based on succinct individualised analysis.     

Effects of septoplasty on the nasal flora

BACKGROUND: Disruption in the balance of the nasal flora influences infectious diseases of the nose. We characterized the changes in nasal flora of the middle meatus of patients with a symptomatic deviated nasal septum before and after septoplasty. METHODS: The study cohort included 33 patients with symptomatic deviated nasal septum who underwent septoplasty from 1998 to 2001. Cultures from the middle meatus were taken preoperatively and 1 month postoperatively. RESULTS: Fifty-two percent of the preoperative cultures and 76% of the postoperative cultures were positive. The preoperatively cultured bacteria were similar to those usually cultured from the nose of a healthy individual-mainly Staphylococcus aureus and Corynebacterium. The postoperative cultures included bacteria not considered as being nasal flora and infrequently cultured from the nose: Pseudomonas, Haemophilus influenza, and Staphylococcus coagulase negative. CONCLUSION: Symptomatic septal deviation does not influence nasalflora. The bacterial changes without clinical complaints that we found postseptoplasty might call for a more in-depth workup.     

About the functional aspect of septorhinoplasty]

INTRODUCTION: Rhinosurgeons emphasize the functional aspect of septorhinoplasty (SRP). So far only a few publications with exact data exist. PATIENTS AND METHODS: Fifty-two patients (33 male symbol; 19 female symbol, average age: 37 years) were examined before and approx. 1 year after SRP. Rhinomanometry, olfactometry, and photographic documentation were carried out. Using a questionnaire they were asked about the functional outcome and about their original personal aims concerning the SRP. RESULTS: All patients suffered from a deviated septum. Regarding the external aspect 38 patients had a crooked nose with or without a hump, 7 patients had a hump without external deviated nose, and 7 patients had a saddle nose or other deformities. If total nasal airflow is considered rhinomanometry showed no significant improvement postoperatively (p=0.115). If only the worse nasal side is considered rhinometry showed a highly significant improvement (p=0.002). In the questionnaire 34 patients (65%) indicated an improvement, 14 patients (27%) no change, and 4 patients a deterioration of the nasal airflow. The final aesthetic outcome was assessed by 39 patients (75%) as an improvement, by 12 patients (23%) as unchanged, and by 1 patient (2%) as worse. There were no significant changes in the olfactory function. Asked about their personal aims 29 patients (56%) wished first of all an improvement of nasal airflow, 5 patients (10%) a good aesthetic result, and 18 patients (34%) both aspects. CONCLUSIONS: The results show that use of the term "functional" SRP is justified. In the majority of cases a simultaneously existing functional-plastic problem is solved. Our results support the importance of rhinomanometry as an objective parameter in the perioperative diagnostic battery of nasal obstruction.     

开放鼻整形术在歪鼻畸形矫正中的应用

目的探索开放鼻整形术在歪鼻畸形矫正中的应用。方法采用鼻开放入路,在直视下根据鼻梁畸形情况,对畸形的鼻骨性支架结构和软骨支架结构等对症处理,矫正鼻梁歪斜,改善通气功能。结果临床应用68例,效果满意。结论开放鼻整形术具有操作灵活、术野清晰、效果确切的临床效果。对歪鼻畸形,尤其是严重的歪鼻畸形,手术效果确切可靠。     

Classification of the deviated nose and its treatment

OBJECTIVE: To present a simplified classification of the deviated nose and the associated treatment outcome. DESIGN: Retrospective analysis. SETTING: Tertiary care rhinology clinic. PATIENTS: Seventy-five individuals (49 males and 26 females) who underwent rhinoplasty for a deviated nose with minimum follow-up of 36 months. MAIN OUTCOME MEASURES: Depending on the orientation of 2 horizontal subunits (the bony pyramid and the cartilaginous vault) with respect to the facial midline, the nasal deviations are classified into 5 types: I, a straight tilted bony pyramid with a straight tilted cartilaginous vault in the opposite direction; II, a straight tilted bony pyramid with a concavely or convexly bent cartilaginous vault; III, a straight bony pyramid with a tilted cartilaginous vault; IV, a straight bony pyramid with a bent cartilaginous vault, and V, a straight tilted bony pyramid and a tilted cartilaginous dorsum in the same direction. RESULTS: Deformities of types I through V occurred in 24 (32%), 19 (25%), 19 (25%), 7 (9%), and 6 (8%) patients, respectively, in whom 1, 3, 2, 1, and 1 unsuccessful outcomes were found. Four of the 8 failed cases had been approached endonasally. CONCLUSION: The proposed classification for the deviated nose could serve as a valuable adjunct in the treatment of these patients.