鼻中隔前端,中隔前颌韧带和鼻前棘复合体切除对兔面…

为探讨手术切除兔鼻中隔软骨前端，中隔前颌韧带和鼻前棘复合体后对面中部生长发育的影响，用２０只２周龄日本大耳白兔，分为实验组，手术切除上述复合体；对照组，只切开不切除，术后２．８，１４，２０，２８周时摄头颅侧位片，分别测量上颌骨长度和高度，鼻骨长度和面角变化情况，结果经统计学处理差异均无显著意义，提示胚胎期鼻中隔软骨通过中隔前颌韧带传导作用，对面中部生长发育起重要作用，但出生后，这种作用即不明显，仅     

鼻中隔前端、中隔前颌韧带和鼻前棘复合体切除对兔面中部生长发育的影响

为探讨手术切除兔鼻中隔软骨前端、中隔前颌韧带和鼻前棘复合体后对面中部生长发育的影响,用20只2周龄日本大耳白兔,分为实验组,手术切除上述复合体;对照组,只切开不切除。术后2,8,14,20,28周时摄头颅侧位片,分别测量上颌骨长度和高度,鼻骨长度和面角变化情况。结果经统计学处理差异均无显著意义。提示胚胎期鼻中隔软骨通过中隔前颌韧带的传导作用,对面中部生长发育起重要作用,但出生后,这种作用即不明显,仅起机械性支持作用。因此早期矫正唇裂鼻畸形不致影响面中部正常发育。     

鼻内窥镜下青少年鼻中隔成形术

鼻中隔偏曲传统手术矫正方法是在普遍照明条件下将鼻中隔软骨大部分切除后用咬骨钳或/和鱼尾凿将偏曲的筛骨垂直板或上颌骨鼻嵴或后方的犁骨切除,使偏曲的中隔得以矫正[1],此术式鼻中隔骨架切除过多,术腔深部照明欠佳,术后易发生鼻塌陷、鼻中隔穿孔、鞍鼻等并发症,且对18岁以下鼻部发育为不全的青少年列为手术禁忌。国外学者通过长期临床观察发现,面中部外伤和鼻中隔手术对鼻和上颌骨的发育无明显影响[2]。据此,我科自1999年1月～2005年5月对22例青少年鼻中隔偏曲严重影响鼻通气、经临床保守治疗不佳者,采用鼻内窥镜下鼻中隔成形术,效果理想…     

鼻中隔软骨和骨性鼻中隔复合体在鼻综合整形术中的应用

目的介绍当自体鼻中隔软骨偏小时采集鼻中隔软骨和骨性鼻中隔(筛骨垂直板)复合体行鼻中隔延伸移植的鼻整形手术方法。方法对行鼻综合整形术者,术中分离鼻中隔黏软骨膜后粗略测量鼻中隔软骨大小。对鼻中隔软骨较小者采集鼻中隔软骨时联合采集部分筛骨垂直板,将软骨和骨联合行鼻中隔延伸移植鼻整形术。结果本组26例患者切口均一期愈合。术后随访6~12个月,医师和患者均对手术效果满意。结论对自体鼻中隔软骨偏小的患者,采用鼻中隔软骨和骨性鼻中隔(筛骨垂直板)复合体联合行鼻中隔延伸移植是一种效果确切、安全可行的手术方法。     

自体鼻中隔软骨游离移植亚洲人鼻延长术

目的 探讨自体中隔软骨移植,改变鼻短小鼻尖圆钝的外形、延长鼻长度、改善鼻尖外形及鼻唇角.方法 松解与塑造鼻翼软骨形后,切取自体鼻中隔软骨行L状移植及帽状移植,并辅以埋线塑形等手段.结果 共完成此类手术345例,经6个月至4年术后随访,均获得满意效果.结论 采用在鼻中隔下端与鼻翼软骨穹窿部行鼻中隔软骨移植的方法加长鼻长度,疗效可靠,且自体鼻中隔软骨取材方便、损伤小、不易发生感染及排异等并发症,值得推广.     

鼻中隔组织与面中部骨组织相互影响的研究进展

鼻中隔是由鼻中隔软骨、筛骨垂直板和犁骨组成,鼻中隔位于面中部的中心,是面中部骨组织的组成部分之一,对面中部的骨组织发育及外形美观有着重要的影响。若鼻中隔偏曲会导致面部两侧不对称及面中部骨组织发育不良等现象;若面中部骨组织异常发育也会影响鼻中隔的正常发育,即导致鼻中隔偏曲。现对鼻中隔组织与面中部骨组织相互影响的作用机制、异常发育现象及治疗时机的选择进行综述,旨为临床治疗鼻中隔偏曲或鼻中隔异常发育导致的面中部发育不良提供参考。     

鼻中隔软骨在耳廓修复中的应用

近几年来,在用自体鼻中隔软骨整复鼻尖、鼻翼畸形取得经验的基础上,我们用鼻中隔软骨修复3例外伤性耳廓部分缺损,取得较为满意的效果。手术方法:①切取鼻中隔软骨尽可能大块切取,肥厚的软骨性距状突亦整条切下。将软骨浸于庆大霉素溶液中备用。若因中隔偏曲有鼻阻症状者,则继续切除偏曲的骨质,至鼻中隔完全正直为止。缝合切口。双侧鼻腔填塞纱条。在耳廓后乳突处设计一     

鼻尖低垂畸形的整复

因鼻翼软骨先天形态异常而产生的鼻尖低垂畸形是一种较常见的只尖畸形。其主要临床表现是鼻尖突出不明显且低垂。鼻背下段呈弧形隆起，全鼻过长。整复手术在局麻下进行，Ｒｅｔｈｉ切口入路，暴露整个鼻翼软骨外侧脚、穹窿部及鼻中隔软骨下端，根据要求条状及楔形切除部分软骨，缝合固定使一翼软骨外侧脚内旋和推进以提高鼻翼软骨内侧脚的高度。用该术式共行１２例手术，其中男性７例，女性５例，术后随访６天～３个月，１０例对手术效果满意，２例认为效果一般。该术式主要适用于一尖低而突出不明显并伴有下垂，但鼻中隔软骨下端形态与高度正常的病例，手术简便，不需要组织移植，鼻尖外形改善明显，长期效果稳定。     

膝关节镜下采用挤压螺钉固定骨—髌腱—骨自体移植重建 …

目的 探讨采用关节镜下微创手术的方法重建膝关节前交刃韧带。方法 在膝关节镜下采用挤压螺钉固定骨－髌腱（中１／３）－骨复合体自体移植重建前交叉韧带， １年以上者２０例，平均随访时间１年５个月。结果 按关节功能评定标准，本组２０全名，优１３列，良５例，可２例，优良率９０％；９例术后关节镜观察重建前交叉韧带的形态结构，７例塑形改建良好。结论 关切镜下重建前交叉韧带手术创伤小，骨道定位准确、固定牢固，可做     

软骨性斜形歪鼻矫正术

目的 总结继发性软骨性斜形歪鼻的治疗经验,探讨行之有效的手术方式,提高临床治疗效果.方法 采用开放式入路,完全显露鼻中隔软骨的前缘和下缘,在一侧的黏软骨膜下剥离鼻中隔软骨,切断其与筛骨垂直板和犁骨的连接,并过度矫正固定其下缘于前鼻棘上,使鼻中隔复位到面正中线上,偏曲明显者予以适当切除中隔软骨,必要时行软骨扩展移植,重塑鼻支架,双侧鼻腔内碘仿纱条填塞同定.本组患者共45例,外伤后畸形者26例,唇裂术后继发畸形者19例.结果 45例患者术后均Ⅰ期愈合.所有患者术后获随访6～12个月,鼻外形均恢复良好,未出现并发症.结论 鼻中隔联合整复术矫正继发性软骨性斜形歪鼻是一种行之有效的手术方法.     

The effect of releasing tip-supporting structures in short-nose correction

Correction of a short nose has been regarded as one of the most challenging and at times vexing procedures in rhinoplasty. One surgical option used to prolong nasal length is the freeing of the alar cartilages from adjacent structures by dividing the nasal tip supporting tissues. Five fibrous connections are known to be important in maintaining the nasal tip shape: fibrous tissues between the upper lateral and lower lateral cartilages; the lateral border of the lower lateral cartilages at the pyriform aperture; the interdormal ligament and anterior septal angle; the footplate of the medial crus and septal cartilage; and the dermocartilaginous ligament. This study was designed to determine which of the fibrous connections providing nasal tip support offer the most effect of lengthening when these structures are divided. We performed 10 open rhinoplasties on fresh cadavers, and we sequentially divided the previously mentioned tip-supporting structures, except the dermocartilaginous ligament. The mucoperichondrium of the upper lateral and septal cartilages was also elevated, in accordance with the usual order of being released in a short-nose correction procedure. We measured the distance between the anterior septal angle and tip-defining points by using calipers while the middle crura of the lower lateral cartilages were stretched with a skin hook. We found that the most effective length was gained by severing the lateral crus from the upper lateral cartilages, and moderate gain was noted from the release at the pyriform aperture and mucoperichondrium of the upper lateral cartilage. Release of other tip-defining structures was not statistically effective.     

Facial skeletal dimensions in patients with nasal septal deviation

The anatomy and the concomitant function of the face seem to be reciprocal issues. Previous studies have shown that stenosis in the posterior part of the nose, hampering nasal air flow, is associated with a retrognathic face and a posterior rotation of the lower jaw, i.e. components of the adenoid syndrome. The present study examines facial cephalometric morphology in adults with a deviated nasal septal cartilage, i.e. an anteriorly positioned nasal stenosis. Compared to a group of unafflicted individuals, also with regard to rhinomanometric resistance, a significantly smaller posterior facial height, smaller height of the anterior nasal aperture, a posterior rotation of the lower jaw and a shorter nasal floor and ceiling were found. This may mean that growth of the nasal septal cartilage and growth of the surrounding skeletal areas are out of step. A relatively undersized skeletal frame, in the sagittal plane, may have led to the buckled non-fitting septal cartilage, with increased air flow resistance as a secondary effect. If this interpretation is correct, an early cautious surgical correction of the septal deviation, also balancing this growth incongruence, might be worth serious consideration.     

Role of the septal cartilage in facial growth. Experimental study in rats

The authors report a surgical experiment on nasal septal cartilage in the growing rat. Three different operations performed on 95 animals to assess. The role of septal cartilage in facial growth and the effects of standard surgical techniques on facial growth. The results obtained show that sub-periosteal dissection of the nasal bones has no adverse effect on facial growth; conservative procedures such as removal and replacement of septal cartilage, produce minimal effects on facial growth, but large septal cartilage excision obviously impairs facial growth. Guidelines concerning septal surgery in children are suggested in view of these results.     

Correction of the nasal tip and columella in Koreans by a complete septal extension graft using an extensive harvesting technique.

The nose of most Koreans is characterised by a low nasal dorsum, retracted columella, and an acute columella-labial angle. For the surgical correction of the tip and columella, a complete septal extension graft, along with augmentation rhinoplasty has been developed. However, the use of this type of graft is frequently problematic because the septal cartilage is not large enough. In a study involving 10 cadavers, a complete septal extension graft was achieved in two of them by using septal cartilage harvested according to standard techniques. Therefore, the septal cartilage was harvested, leaving a 5-mm L-shaped strut, and a complete septal extension graft was implanted. The present report describes the results obtained in 34 patients and offers an analysis of the results as judged by the columella-labial angle and three proportional indices (nose height index, nasal bridge length index, and nasal tip projection index), measured by photogrammetry. The postoperative values obtained in these four categories increased significantly compared to the preoperative ones, thus confirming that the projection of tip was augmented, the nose was lengthened, and the columella was advanced caudally. Moreover, these positive outcomes were maintained during long-term follow-up, and no side effects, such as saddle nose deformity, were reported.     

鼻中隔软骨游离移植矫正鼻尖圆钝肥大

目的 探讨以自体鼻中隔软骨移植在鼻尖圆钝螯形术中的应用.方法 取1整块自体鼻中隔软骨片,移植于鼻中隔软骨前端,作为鼻中隔延伸支架,将两侧鼻翼软骨收拢缝合固定于支架上.同时,剪除部分外侧脚近端软骨,修剪鼻尖过多的软组织,以突出鼻尖轮廓.结果 126例,术后随访1年,118例（94%）效果满意,8例因鼻尖皮肤过厚,效果未达到患者满意程度.结论 临床实践证明,所介绍的方法 是治疗鼻尖圆钝肥大的良好可行方法.     

自体鼻中隔软骨移植在鼻尖成形术中的应用

目的探讨自体鼻中隔软骨移植在鼻尖成形术中的应用。方法在双侧眶下神经阻滞麻醉下,采用“飞鸟形”切口显露鼻尖部。充分游离鼻翼软骨,切取2cm×1cm的鼻中隔软骨备用。将鼻中隔软骨切取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。将剩余的鼻中隔软骨修剪塑形后,移植于鼻尖和鼻翼软骨表面。结果15例患者中,13例经3个月至1年半的初步随访,鼻尖形态均有不同程度的改善,效果满意。结论自体鼻中隔软骨是鼻尖成形术中较好的充填材料,没有排斥反应,值得进一步推广。     

BMSCs复合PHBV原位修复兔鼻中隔软骨缺损的实验研究

目的探索BMSCs复合PHBV原位修复兔鼻中隔软骨缺损的可行性。方法建立兔鼻中隔软骨缺损模型。将36只健康新西兰大白兔随机分成3组。实验组:软骨缺损处植入BMSCs-PHBV复合物进行修复;对照组:软骨缺损处植入单纯PHBV支架材料进行修复。空白组:单纯取出鼻中隔软骨,不予修复。分别于16、24周取材,行大体观察及组织学检测。结果大体观察显示,实验组新生软骨样组织将鼻中隔软骨缺损区填充修复,与周围软骨组织未见明显分界;对照组新生软骨薄,与周围组织分界明显;空白组鼻中隔软骨缺损区未生成软骨组织,缺损部位及其周围正常软骨组织被纤维结缔组织充填覆盖。组织学检测显示,实验组构建的软骨组织结构致密,基质及Ⅱ型胶原显色程度均明显强于对照组构建的软骨。结论 BMSCs-PHBV复合物能有效修复兔鼻中隔软骨缺损。     

Rhinolift operation in the treatment of the aging nose

Disturbance of the normal relationship between the caudal border of the upper lateral cartilage and the cephalic margin of the lobular cartilage--the so-called "cul-de-sac" area--can result in alar collapse and nasal airway obstruction. This may be caused by either the aging process or trauma, both surgical and nonsurgical. Rhinolift is a surgical procedure that was developed for the treatment of the aging ptotic nasal tip. We have applied this technique to patients with nasal airway obstruction resulting from alar collapse. Elevation of the cephalic margin of the lobular cartilage to a position superficial to the upper lateral cartilage restores the normal relationship between these two structures. The upper lateral cartilage then assists in stenting the vestibule open, and thereby improves nasal breathing. Over the past 10 years, 20 patients have had rhinolifts at our institution for the relief of nasal airway obstruction. Concomitant surgery included nasal septal reconstruction in 12 patients, polypectomy in one patient, and placement of a silicone rubber septal prosthesis for closure of a large septal perforation in three patients. Rhinolift was the sole procedure used for the correction of valvular pathology in 10 patients. The other 10 patients had modifications made in their upper lateral cartilage along with the rhinolift. Five patients described restoration of normal nasal breathing, while 14 patients showed partial symptomatic improvement. One patient reported no improvement in nasal breathing. Rhinolift is a safe effective surgical technique for functional improvement of nasal breathing in patients with alar collapse resulting from inadequate cartilaginous support.     

自体肋软骨移植构建鼻尖软骨复合体在鼻整形中的临床应用

目的：通过应用自体肋软骨重塑鼻尖软骨支架结构,形成稳定的鼻尖软骨复合体,来达到完美、立体的鼻尖外形,同时应用膨体聚四氟乙烯或硅胶假体支架抬高鼻背,从而达到理想的鼻部整形美容效果。方法：以鼻小柱基底部＂几＂字形切口和鼻孔内鼻翼软骨外侧缘切口,彻底分离皮肤达鼻翼基底部,对鼻尖短小朝天者可松解到达梨状孔边缘,显露两侧鼻翼软骨及侧鼻软骨,同时暴露鼻中隔软骨游离端;雕刻自体肋软骨,移植、固定到鼻中隔软骨上,贯穿缝合鼻翼软骨、移植的软骨,形成鼻尖软骨支架结构,构建鼻尖软骨复合体。雕刻膨体聚四氟乙烯或硅胶假体支架放置到鼻背鼻骨骨膜下抬高鼻背。结果：本组96例手术者均采用自体肋软骨移植构建鼻尖软骨复合体行鼻整形,术后7天拆线,切口Ⅰ/甲愈合。随诊6～12个月,95例术后鼻尖表现点明显,鼻形立体、挺拔,自然美观,鼻尖活动度好,效果满意。1例术者感觉鼻小柱下垂,通过修复移植软骨,达到满意效果。结论：应用自体肋软骨重塑鼻尖软骨支架结构,构建鼻尖软骨复合体,同时应用膨体聚四氟乙烯或硅胶假体支架抬高鼻背,可以达到理想的鼻部整形美容效果。