隆鼻术后鼻端形态不佳的修整方法探讨

目的 探讨隆鼻术后鼻端形态不佳的原因和处理方法。方法 对隆鼻术后鼻端形态不佳的鼻尖前凸、鼻尖圆钝、鼻尖低平、鼻孔外翻和两侧不对称等，采用更换或重新雕琢假体、重塑鼻的软骨支架、充填自体软骨和推进皮瓣等方法，对116例受术者进行了鼻端修整术。结果 经过1个月至5年的随访观察，除3例肿胀消退时间较长，2例线结反应外，其余受术者均获得了满意的手术效果。结论 熟练掌握鼻假体雕琢技术以及合理应用鼻端修整的手术方法，调整鼻的软骨支架和皮肤瓣的位置，是获得满意手术效果的基础。     

New nasal fracture classification for patients with silicone implants

Abstract

Aesthetic nasal augmentation has increased in popularity among Asian populations, and nasal bone fracture is the most common type of facial bone fracture. In Asia, the frequency of nasal bone fractures is also increasing among patients who have undergone silicone augmentation rhinoplasty. The increasing prevalence of this injury presents a challenge to the surgeon. Thirty-six patients who had previously undergone augmentation rhinoplasty with silicone implant presented with nasal bone fracture from June 2007 through December 2011. The patients were grouped into three categories: patients with fractures in the high level (type I), patients with fractures in the low level (type II), and patients with fractures throughout the entire nasal bone, from base to top (type III). The largest group comprised patients with type I fractures (n = 24, 67%), followed by type II (n = 4, 11%), and Type III (n = 8, 22%) fractures. Symptoms and surgical outcomes for nasal bone fractures may be different in patients with silicone implants. A novel classification system for nasal bone fractures is required, as is a new approach to diagnosis and treatment.     

The classification of complications after augmentation rhinoplasty

The authors classify the complications resulting from augmentation rhinoplasty into 6 typ3s according to the nasal areas involved, then guide the reader to the corresponding technique of management for each type. Their classification is based on the data of 113 patients whom they treated with a secondary rhinoplasty in their clinic during the past 10 years. In the case of augmented noses, it is especially noted that removal of the implant must precede any further treatment in a secondary rhinoplasty.Presented at the 6th Congress of the International Society of Aesthetic Plastic Surgery, Tokyo, September 28, 1981     

Three-dimensional reconstruction of a defect of the frontozygomatic area by custom made Proplast II implant

Alloplastic materials are a valid alternative to autologous bone grafts in contour defects of the facial skeleton. Biomaterials also reduce donor site morbidity. In addition, alloplastic materials can be contoured exactly as needed. Computed tomography (CT) scan digital data can be computed into three-dimensional data for 1:1 stereolithographic reconstruction of the complete skull or segments as required. The design of an implant for defect reconstruction may even be computed as a mirror image of the unaffected undeformed side. Therefore it is common to perform phantom operations on stereolithographically built models from the patient’s head before a complex reconstruction is done. Proplast II has an advantage over other materials, such as hydroxyapatite, titanum, gold, silicone, and polymethylmetacrylate (PMMA), because of the low weight, the fact that the material can be carved with a sharp scalpel, and the possible integration into fibrous and bone tissue. Proplast II is semirigid and can easily be sutured to the bony defect. Received: 15 March 2000 / Accepted: 25 April 2000     

应用自体鼻中隔软骨与自体真皮组织修复假体隆鼻术后远期并发症的临床研究

目的探讨应用自体组织综合性修复假体隆鼻并发症的方法和疗效。方法针对36例固体硅胶假体隆鼻术后鼻背、鼻尖发红及鼻尖假体显露、穿出的患者,采取经鼻小柱开放性切口取出假体,剥除包膜,应用患者自体鼻中隔软骨及臀部真皮组织进行综合鼻整形修复。自体鼻中隔软骨应用于鼻小柱支撑及鼻尖覆盖物,白体真皮组织去表皮及脂肪后,修剪成合适形态,置于鼻背及鼻尖处,修复变薄的皮肤组织,塑造合适的形态。结果本组共36例患者,术后均I期愈合;术后未出现感染、软骨外露及移位等情况,疗效满意。结论自体鼻中隔软骨联合真皮组织移植,可有效修复假体隆鼻引起的并发症,术后外观形态好,值得临床推广。     

膨体聚四氟乙烯联合硅胶假体在隆鼻术中的应用

目的：探讨膨体聚四氟乙烯与固体硅胶假体联合植入进行隆鼻的方法.方法：将雕塑好的膨体聚四氟乙烯固定在L形硅胶假体鼻尖部,形成膨体-硅胶假体联合体,进行鼻背筋膜下隆鼻.结果：本组71例受术者经6个月～1年随访,均出现极大程度的外形改善,所有患者均未出现假体外露,感染,鼻尖皮肤破溃等并发症,均获得满意临床效果.结论：应用膨体聚四氟乙烯联合硅胶假体隆鼻操作简单、有效,适合推广应用.     

Removal of bioplastique after nasal augmentation

Summary Nasal augmentation with bioplastique can produce visible irregularities under the nasal skin, and when this occurs, the material should be removed. A case is presented where bioplastique was removed from the naso glabellar area through a Réthi incision and the bridgeline reconstructed with a conchal cartilage graft.     

鼻缺损修复术中美学亚单位原则的应用

目的探讨鼻美学亚单位原则在鼻部缺损修复和再造术中应用的效果和意义。方法鼻部各亚单位缺损患者共27例,根据鼻美学亚单位分区分为5组,为鼻背、鼻尖、鼻翼小叶、软组织三角以及涉及两个或两个以上亚单位组。根据缺损面积占亚单位的比例,对小于50%的缺损作亚单位局部修复,大于50%的则去除残余组织,行全亚单位重建。其中,游离组织移植(如植皮、耳廓复合组织移植)10例,局部皮瓣4例,额部皮瓣13例,术后随访5~37个月,以修复后的鼻外形和色泽来判断修复和再造效果。结果植皮、局部转移皮瓣14例全部存活;耳廓复合组织游离移植2例出现表皮发红发暗,半年后皮肤色泽渐趋正常;额部皮瓣鼻再造13例中,有1例出现鼻小柱伤口愈合不佳,鼻假体外露,鼻小柱瘢痕增生挛缩,二期行上唇黏膜瓣带蒂转移修复治愈。27例全部得到随访,患者和家属对手术结果均表示满意。结论运用鼻亚单位原则进行鼻部缺损修复和再造,与传统方法比较,能够获得更为满意的效果。     

自体耳屏软骨在鼻尖整形术中的应用

目的 探讨自体耳屏软骨移植在鼻尖整形术中的应用价值.方法 切取一侧或两侧大部分自体耳屏软骨,将其切取1条移植于鼻翼软骨内侧脚之间,相互缝合后,延长鼻小柱并抬高鼻尖.将余下的耳屏软骨修剪塑形后,移植于鼻尖和鼻翼软骨表面,或联合使用人工鼻假体材料(膨体聚四氟乙烯或硅胶)同期行隆鼻术.结果 本组共156例求美者,其中35例失访,121例随访3～48个月.鼻尖形态均有不同程度的改善,效果满意;供区耳屏外形正常.结论 耳屏软骨是鼻尖整形术中自体软骨的较好来源;其方法简单,效果良好,值得在临床上推广应用.     

自体耳甲软骨移植联合假体置入隆鼻术

目的探讨自体耳甲软骨移植联合假体置入隆鼻术的效果和优点。方法将自体耳甲软骨雕刻后移植于鼻尖和鼻小柱,假体置入鼻根鼻梁。结果手术1年后随访106例,105例临床效果满意,鼻部外形自然、未发生假体下滑、移位和外露等现象。1例因隧道分离过宽,术后受术者强烈要求不包扎固定而出现假体歪斜,手术修复后效果满意。结论自体耳甲软骨移植联合假体置入隆鼻术,不仅使鼻的外形更加优美自然,而且可避免假体下滑、移位和外露等并发症的出现,值得临床推广应用。     

注射法超微粒人工骨隆鼻术

目的　为部分鼻梁高度仅需增加少量或只对鼻子某个部位填充的患者塑造一个完美的鼻形。方法　采用特制的注射器配 14号长穿刺针 ,贴骨面刺入 ,边退边缓缓注入超微粒人工骨 ,至外形满意。结果　 68例患者经半年以上的随访 ,外形满意者 5 6例 ,占 82 .3 % ;外形较原来有较大改善者 8例 ,占 11.7% ;外形不满意者 4例 ,占 6%。结论　采用注射超微粒人工骨隆鼻术可达到满意的临床效果 ,对于那些需精雕细凿、修修补补的隆鼻者 ,不失为一种较好的手术方法     

鼻中隔软骨联合自体真皮组织在鼻综合整形术中的应用

目的探讨应用鼻中隔软骨行鼻尖塑形,并联合采用自体真皮组织隆鼻的临床疗效。方法本组36例求美者均采用鼻小柱开放式切口,应用自体鼻中隔软骨,根据需要做鼻小柱支撑物、鼻尖移植物或鼻中隔延伸移植物;于臀下皱襞处取真皮组织瓣,去除表皮及皮下脂肪,切开真皮,缝合成多层置于鼻背筋膜下,妥善固定。结果36例求美者术后无切口感染裂开及软骨外露,鼻外形自然饱满,鼻尖表现点明显,侧面观弧线圆润。术后随访3个月至2年,切口无明显瘢痕增生,鼻外形无显著变化,效果满意。结论鼻中隔软骨联合自体真皮组织移植是综合鼻整形中的有效方法,值得临床推广应用。     

Reconstructive rhinoplasty with nasal implants

A new method of immobilizing nasal implants is the creation of a strong fibrotic reaction with sewn polyester (Dacron) felt. It has been applied to saddle nose deformity, as well as maxillary retrusion of flat nasal tip. Over a period of 15 years in a large number of cases, the complications have been only a temporary inflammatory reaction in 5% of the cases.     

隆鼻术后硅胶假体外露的原因及防治

目的：探讨硅胶假体隆鼻术后假体外露的原因及防治措施。方法：对16例鼻假体外露就医者,手术取出假体,根据假体外露部位,雕刻形态、隧道层次、切口位置等分析假体外露的原因,从而提出预防措施及提高手术效果的方法。结果：16例中,6例假体短臂由鼻小柱侧缘切口穿出,5例假体由鼻尖下点穿出（其中3例为柳叶形假体）,3例由鼻前庭切口穿出,其中1例合并感染,2例经鼻背皮肤穿出。取出的假体形态：柳叶形假体雕刻太尖,L形假体短臂过长而长臂宽厚、假体叠加等。结论：假体与鼻头、鼻背不相称导致置入后张力过大或假体形状雕刻欠佳是假体外露的根本原因。因此,隆鼻术后使假体处于无张力状态以及提高假体雕刻技巧是避免假体外露的主要措施。     

Open rhinoplasty for treatment of nasal tip haemangioma

Haemangiomas are the most common tumours of infancy. They typically proliferate then involute with considerable variation as regards to their rates of proliferation and involution. Haemangioma of the nasal tip is a lesion of special characteristics. During proliferation, it expands, contracts and deviates the nasal cartilages. Particularly, it regresses slowly and frequently involutes incompletely. That is why excision of the lesion is frequently suggested. The present study was conducted to evaluate open rhinoplasty after initial non-excision treatment modalities namely, intra-lesional corticosteroid injections and laser treatment, as a protocol of treatment for nasal tip haemangiomas. Twelve patients with nasal tip haemangiomas were included in the present study. Patients of both sexes, of different ages, with deep and mixed haemangiomas were studied. Disfigurement was the constant presenting symptom. Initial non-excision treatment reported different responses as denoted by the regression of the lesions’ size. Haemangiomas constantly extended between the medial crura of the alar cartilages as noted by the constant widening of the columella pre-operatively and the obvious separation of the nasal cartilages intra-operatively. This separation was constantly found to require approximation by sutures. The results of the present study concluded that whenever an early presentation with nasal tip haemangioma could be established, initial non-excision treatment followed by open rhinoplasty could be a useful protocol of treatment. Within the limitations of the present study, this protocol could achieve an early, safe and effective treatment for nasal tip haemangiomas with provisionally acceptable cosmetic outcomes so far.     

鼻背筋膜下鼻假体置入隆鼻176例总结分析

目的：寻求隆鼻手术的最佳层次并探讨术中注意事项。方法：对176例鼻梁低平者，行鼻背筋膜下放置鼻假体支架进行隆鼻手术，并进行总结分析。结果：170例术后隆鼻效果满意，满意率达96．6％以上。6例因假体形态不佳、偏移而再次手术，经再次手术后3个月～2年的随访观察，除2例肿胀消退时间较长外，就医者对术后效果均满意。结论：由专科医师实施手术是减少隆鼻术失败的关键。采取一些措施后鼻背筋膜下放置鼻假体支架行隆鼻手术可取得较好手术效果，是一种可行的方法。     

综合外鼻美容手术的美学设计与探讨

目的 探讨在一次手术中对外鼻进行综合美容整形的方法，以获得符合美学规律的鼻外形。方法 针对患者鼻部外观的缺陷，参考额鼻角、鼻唇角、鼻长宽比、鼻尖角和弦等鼻部美学指标，综合的设计手术方案和手术方法。并对行综合外鼻部美容手术的32例患者进行分析。结果 经1～6个月的随访，行综合外鼻美容手术的32例患者中28例满意，占87．5％。结论 采用综合外鼻美容手术的设计方案和手术方法，能获得较满意的术后效果，综合外鼻美容手术值得推广和应用。     

也论骨膜下隆鼻术的解剖学基础及临床应用

对３５例成人尸体鼻标本的解剖学观测，发现鼻骨骨膜厚约０．４２ｍｍ，致密坚韧，其固定作用明显好于其它各层鼻背软组织。解剖显示，以专用隆鼻器械在标本上模拟健康人隆鼻术方法行鼻骨骨膜下分离是可行的，可形成一完整或较完整的骨膜下腔隙，而利用普通刀剪则不能形成。利用自行研制的专利产品隆鼻假体导入器辅助手术，可使鼻假体快速而准确的置入，大大缩短了手术时间，有效地减少了并发症的发生。临床应用６５例，取得了良好的效果，本文就骨膜下分离及临床应用的有关问题进行了讨论。     

自体肋软骨隆鼻术的效果观察

目的 探讨应用自体肋软骨行隆鼻术的方法和效果.方法 自2010年3月至2014年2月,我们应用自体肋软骨对9例患者进行了隆鼻术.切取右侧第7肋软骨,长5～6 cm,雕刻成“柳叶”形.选择鼻小柱侧切口,鼻骨骨膜下钝性分离,形成相应的软骨植入腔隙;将雕刻好的“柳叶”形软骨植入腔隙,并将剩余软骨修剪成“盾牌”形,植于鼻尖点.结果 本组共9例患者.1例患者术后出现肋骨切取伤口脂肪液化,其余患者手术切口均Ⅰ期愈合;1例术后鼻背软骨轻度弯曲,其余患者鼻外形改善,效果满意.结论 自体肋软骨隆鼻效果良好,克服了假体隆鼻的缺点.