黄种人鼻整形的研究进展

黄种人的鼻整形是在鼻整形领域中的一个扩展性的研究命题。虽然各种鼻整形技术的主要原则同样适用于黄种人．但由于种族因素和解剖学差异,黄种人的鼻整形有其独有的特点。在近些年的研究中,黄种人的鼻部整形呈现一些值得注意的进展。本文就黄种人群鼻整形中鼻背部整形、植入材料、鼻尖成形及隆鼻后并发症处理方面等的最新进展进行综述。     

眶距增宽症鼻成形术

目的 总结59例眶距增宽症鼻成形术的临床经验,以期探讨眶距增宽症鼻畸形整复的方法。方法 鼻部整复术大多采用眶间鼻背部正中V形切口,部分采用矢状切口,面裂鼻尖缺失者,鼻背皮肤行V-Y成形术向下推进延长鼻梁,严重者全鼻下部向下推进,鼻背部骨膜下移修复,鼻腔衬里缺损,眶间鼻部鞭骨缩窄鼻宽度,鼻支架发育不全可植入自体骨填高鼻梁,鼻小柱短小者植入物修成L形,移植骨用螺钉或钢丝结扎固定。结果 本组病例鼻梁宽度平均缩窄2cm,鼻深增高0.6cm,鼻长度延长0.8cm,16例雨季期行鼻部瘢痕修整术,4例由于鼻梁低平二期再行植骨术,无植骨感染坏死、外露排出并发症,结论 眶距增宽症都有外鼻畸形,矫正眶距时可同期行鼻成形术,V-Y成形术可有效地延长鼻梁,鼻背部骨膜向下推移可修复鼻腔衬里缺损,采用肋骨填高鼻梁较为理想,部分病例需行二期手术。     

应用螺旋CT三维重建鼻骨形态鼻内镜下歪鼻矫正术

目的 探讨应用螺旋CT三维重建鼻骨形态鼻内镜下矫正歪鼻畸形的手术治疗方法.方法 对66例歪鼻畸形患者术前行螺旋CT三维重建鼻骨形态,了解歪鼻畸形的局部形成状况.先在鼻内镜下行鼻中隔偏曲的矫正术,后经鼻前庭前小切口在鼻内镜辅助下行歪鼻畸形矫正.结果 术后1周、1个月、3个月及半年后随访,观察外鼻形状,并测量其偏离值.66例歪鼻中矫正效果优为53例,良好为11例,不满意2例.结论 螺旋CT三维重建鼻骨形态可在术前充分了解歪鼻畸形局部及周围情况;采用鼻内镜能充分暴露骨折畸形愈合部位,避免破坏整体框架,使得手术创伤小,手术时间短,术后反应轻,皮肤坏死可能性减小等,因此应用螺旋CT三维重建鼻骨形态鼻内镜下矫正歪鼻畸形效果更具优势.

Abstract：

Objective To discuss the endoscopy-assisted surgery for deviated nose with the preoperative 3-D CT reconstruction. Methods Sixty-six cases with deviated nose deformities underwent preoperative 3-D CT reconstruction. The deformities were showed in detail. The deviated nasal septum and deviated nose were corrected with the assistance of nasal endoscopy. Results The patients were visited after operation at 1 week, 1 month, 3 months and 6 months. The nose shape and nose deviation were measured. Among the 66 cases, satisfactory result was achieved in 53 cases, good in 11 cases,unsatisfactory in 2 cases. Conclusions Preoperative CT reconstruction is very help in understanding the deviated nose deformity. The rhinoplasty with nasal endoscopy has good exposure of the fracture deformity with less morbidity and side effect. The intraoperative time can be decreased also.     

Dissection of the medial crura as a standard procedure in rhinoplasty: Case studies

In the systematic approach to rhinoplasty, the author routinely uses an intercartilaginous columellar incision for dissection and reconstruction of the nasal tip, especially to facilitate separation of the tip cartilages from other tissues in the lower third of the nose. This technique has been used by the author for more than ten years and its advantages are demonstrated.     

隆鼻硅胶假体雕刻中的四个角度

目的探讨隆鼻硅胶假体雕刻中的四个角度与隆鼻并发症的关系。方法总结了420例硅胶假体隆鼻术患者,分析并发症与假体雕刻的关系,提出假体雕刻要与鼻部解剖形态相吻合的四个角度。结果术后1周,发现3例患者假体鼻根部向一侧轻度偏斜,2例6个月后鼻根部假体固定不良。1例术后主诉头痛,取出假体后症状消失。其余未发生并发症。结论假体雕刻与鼻部解剖形态的四个角度相吻合,可以减少并发症的发生,提高美容效果。     

自体鼻中隔软骨短鼻延长及鼻尖成形术

目的利用自体鼻中隔软骨,对短鼻畸形的患者行鼻部延长及鼻尖成形术,手术易行,在西方国家得到广泛的应用,但西方人与东方人的解剖结构及审美观有所差异,如何使这一手术方法更适合东方人,这是一些整形外科医生探索的目的之一。方法从1998年以来,韩国大邱S-整形医院、LOGOS整形医院、天主教大学医疗病院整形与重建外科的326例短鼻或鼻尖低矮的病人,女298例,男28例。使用鼻孔侧切口入路、鼻小柱切口入路采集鼻中隔软骨,利用中隔软骨延长鼻部长度并利用部分雕刻成形的软骨延长鼻尖部、采用或不采用硅胶假体对鼻梁部充填。结果效果良好,平均鼻部延长5mm,手术时间平均约为1小时50分钟。平均随访3年,未见明显吸收及变形、感染、排异现象。结论利用自体鼻中隔软骨,对短鼻畸形的患者行鼻部延长及鼻尖成形术是个安全有效的方法。     

Extramucosal method in rhinoplasty

Principles, history, terminology and technique of the extramucosal method in rhinoplasty are presented. The advantages of preserving the mucosa are reviewed: less bleeding, less swelling, fewer nasal breathing troubles, prevention of parrot's beaked nose, support for skeletal grafts, easier method for secondary rhinoplasty if it is needed, facility in measuring the skeletal resections.     

鼻中隔软骨充填驼峰鼻整复术

目的 介绍用鼻中隔软骨充填整复驼峰鼻的方法。方法 为30例驼峰鼻患者在黏膜下切取鼻中隔软骨，将其分成2～3部分，缝合在一起，移植于驼峰样突起的上下两端鼻背相对凹陷处，使鼻背恢复平直外观。结果 30例患者长期随访，效果均较满意。结论 鼻中隔软骨充填整复驼峰鼻是一种新的有效方法。     

Nasal anatomy: The muscles and tip sensation

The author stresses the importance of columellar sensation, nasal tip sensation, and the role of the nasalis muscles in determining the postoperative results of corrective rhinoplasty, especially as these have an influence on the drooping tip and the columellar base. Specific anatomic details of this area are emphasized in order to help the plastic surgeon understand better the normal anatomy of this region and the effects that operative procedures have on successful results if the surgeon understands especially the role of the nasalis muscles.     

单侧唇裂继发鼻畸形的修复

目的 通过分析单侧唇裂鼻畸形成因、病理解剖改变,探索修复单侧唇裂继发鼻畸形有效可靠的方法.方法 57例单侧唇裂继发鼻畸形患者,采用颌骨裂隙植骨,鼻翼软骨两内侧脚间植入髂骨皮质骨片,依健侧鼻孔形态,选择鼻翼软骨截断部位和悬吊方式,重建鼻翼软骨肌肉环,术后用管状支撑物插入鼻孔保持3个月.结果 术后将鼻翼塌陷、鼻尖、鼻孔、鼻小柱与术前对比评价,满意率为93%（53例）.术后随访3～24个月,52例疗效稳定,5例出现轻度复发.结论 单侧唇裂继发鼻畸形成因复杂,通过颌骨、鼻翼软骨、鼻唇肌肉组织的综合矫治,可有效地改善畸形.并通过稳定牢固的悬吊和恢复肌力的平衡,增强疗效的稳定性,可有效地改善畸形.     

Mental health correlates of valid perception of nasal deformity in female applicants for aesthetic rhinoplasty

Thirty-four female applicants for rhinoplasty were assessed prior to undergoing surgery by means of a measuring scale for objective evaluation of the nasal shape. This scale yields an objective nasal deformity score as well as a measure of validity of subjective perception of nasal shape (nose image) and deformity. Subjects were assessed also for identity integration by a short measure of Eriksonian identity, and for psychological well-being and self-acceptance by means of the appropriate California Psychological Inventory (CPI) scales.Degree of nasal objective deformity was found to correlate with various aspects of positive mental health, namely, identity integration, psychological well-being, and self-acceptance. Validity of nose image was also correlated with identity integration. Findings are in accord with former investigations and call attention to the need for careful selection and management of patients for rhinoplasty, especially when deformity is mild.     

The quantification and distribution of nasal sebaceous glands using image analysis

The distribution of sebaceous glands in nasal skin is of interest because the presence of these adnexal structures significantly influences the outcome of healing. Using whole nasal skins dissected from cadavers, we prepared tissue sections from the nasal bridge to the nasal tip, both from the midline and lateral aspects. The sebaceous glands in these sections were analyzed for the following parameters: (1) size of the glands, (2) width of luminal cross-sections, and (3) depth of the glands. These parameters were studied using a Leitz Quantimet 500 Plus image analyzer and software to quantify the results. We found that the superior or proximal nasal skin contains fewer, smaller, more superficially located sebaceous glands. The inferior or distal nasal skin contains increased numbers of sebaceous glands which are markedly larger in size. The glands in the distal nose have larger lumina, are situated both superficially and deep in the dermis, and also occupy a greater percentage of the dermis. We identified an anatomical breakpoint on the nasal skin, marking the transition from superficial, small sebaceous glands to superficial-and-deep, enlarged glands. The columella was found to be similar to the proximal nasal skin.     

鼻整形术中应用膨体聚四氟乙烯治疗鼻尖低平

目的探讨膨体聚四氟乙烯（expanded pytetraflu-oroethylene，ePTFE）在隆鼻术中治疗鼻尖过低、鼻孔显露的手术方法，以减少传统手术方法的并发症。方法取鼻正中蝶形切口加双侧鼻翼缘切口行ePTFE加强型补片隆鼻术及治疗鼻尖低平。结果应用ePTFE加强型补片为536例患者隆鼻术及治疗鼻尖低平术。术后随访3个月至6年，满意者533例，占99．4％，不满意3例，占0．6％，3例患者术后出现伤口感染，取出ePTFE假体，并于3个月后重新行ePTFE假体隆鼻术，效果满意。结论应用ePTFE在隆鼻术中治疗鼻尖过低、鼻孔显露，可以明显减少传统手术方法的并发症，术后效果理想。     

Traumatic nasal deformities

Lateral deviations of the nose can be caused by various violent injuries or even by unsuccessful surgery (iatrogenic). Early treatment of fractures is not only bloodless but very much easier in contrast to older injuries which can only be corrected by surgery. Under these circumstances, a complete revision and repositioning of the upper and inferior lateral cartilages or alar cartilages is advisable. In both cases, the simultaneous correction of the affected septum is fundamental. The authors recommend packing of the nasal cavities for 5 days and immobilization with an aluminum splint for 7 days.     

鼻内镜下鼻-鼻中隔整形术治疗外伤性歪鼻畸形

目的总结鼻内镜下治疗外伤性歪鼻畸形的经验。方法选择外伤性歪鼻畸形患者42例,其中“C”型偏曲15例,“O”型(偏斜型)偏曲17例,“S”型偏曲10例,分别在术前、术后测量其偏离值(“S”型两个偏曲,暂未进行统计),在鼻内镜下行鼻-鼻中隔整形术,术后进行随访。结果32例“C”型偏曲、“O”型偏曲术前测量偏离值为(5.68±2.03)mm,术后测量偏离值为(2.17±1.09)mm,经配对t检验,手术前后歪鼻的偏离值差异有显著性意义(t=6.877,P<0.001),临床治愈率占62.5%、有效率占87.5%。结论鼻内镜下鼻-鼻中隔整形术是治疗外伤性歪鼻畸形有效的术式,能同时解决鼻腔美学和鼻腔功能的问题,并具有精确、微创、复发率低等优点。     

Secondary rhinoplasty

A secondary rhinoplasty can and should be performed when the primary procedure is unsuccessful. There are many reasons for failure of a primary rhinoplasty, some unrelated to the surgeon's skill or the nasal anatomy, such as inflammation or epistaxis. Improper healing of parts of the nose may result in defects, as will improper application of surgical technique. A secondary rhinoplasty should be performed only after a careful examination of the entire nasal area, including a soft-ray radiographic examination of the osteocutaneous profile. We performed this secondary procedure in 70 patients between 1963 and 1978.     

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.     

中国汉族青年女性鼻尖活动度的测量及临床意义

目的调查中国汉族青年女性的鼻尖活动范围，并与隆鼻受术者的鼻尖活动范围对比，完善我国外鼻测量内容．为鼻整形提供形态学资料及术后评判指标。方法选用100名普通青年女性和30名植入人工材料的隆鼻术后女性的外鼻，确定鼻的活动临界点A，测量鼻尖活动度（左、右）、A点至鼻尖距离（A—P）和鼻长。结果中国正常汉族青年女性鼻尖活动度35．73°±4．72°．隆鼻后鼻尖活动度22.45°±7．53°．两者有明显统计学差异。正常青年女性的A—P间距为（16．62±1．95）mm，隆鼻后为（25．89±10．16）mm。鼻长均在正常范围内。调查发现受术组中有63％感知鼻尖活动度下降，30％因此对手术效果欠满意。27％术后不会当众碰触鼻端，7％对此十分在意。结论应用直接测量法为鼻整形提供有参考价值的鼻尖活动度的正常值，并证实植入人工材料的隆鼻术降低鼻尖活动度，进而影响受术者对手术效果的评价。     

A Useful Method for Planning Hump Resection of Deviated Nose

The deviated nose is a particular challenge because both functional and aesthetic problems must be addressed. A most important challenge is resection of the hump. The nasal bones often are asymmetric in deviated noses. Several methods have been used for resection of the hump. Using the authors’ method, it is possible to calculate the extent of hump resection. Clinical analysis of the nasal deviation is performed preoperatively. Digital photographs are taken, and all the landmarks are marked on the life-size photo prints. Planning begins on the deviated side. The ideal dorsal line is drawn, and the extent of hump resection is planned according to the preoperative measurements. Measurements on the deviated side are applied to the other side using the medial canthi and the most prominent part of the alar creases as landmarks. Classical methods emphasize the importance of the chisel position during hump removal. According to the classical approach, the chisel should be positioned lower on the deviated side to resect more bone. However, there is no method for calculating how the chisel should be positioned exactly during hump resection. Therefore, a precise plan has been devised to leave symmetric nasal bones after hump resection. The authors have applied this method in eight cases, achieving satisfactory results.     

Securing of the nasal skin under the cast in rhinoplasty

The author suggests a method to protect the skin of the nose from vascular impairment, bruising, necrosis, and other complications by interposing between the nasal skin and the overlying splint or cast a protective layer of a soft delicate material such as Telfa^® or Scrylin^®.