耳屏软骨在鼻尖和鼻小柱整形中的应用

目的:探讨鼻尖和鼻小柱整形中双侧耳屏软骨的应用。方法:切取双侧耳屏软骨,将一侧软骨沿长轴从中央不全层切开,翻转重叠形成Y形支撑杆,将另一块耳屏软骨盖在Y形杆上方,行成伞状软骨冒。飞鸟形切口切开鼻翼及鼻小柱,根据情况在鼻小柱下方可设计成V-Y切口。植入已做好的伞状软骨架,如鼻梁较低可同时植入假体隆鼻。结果:27例患者鼻尖均得到抬高,鼻小柱均有不同程度的延长。耳屏切口隐蔽,外形无明显改变,满意率达100%。结论:采用双侧耳屏软骨鼻尖成形,具有形象逼真,效果好,取材简单等特点,是鼻尖整形较好的软骨供体。     

鼻小柱支撑移植物在鼻尖整形中的作用

目的：探讨鼻小柱支撑移植物在鼻尖整形中的分类、材料组成,作用及使用方法。方法：70例鼻尖整形病人中,均使用鼻小柱支撑移植物,其中使用鼻中隔软骨48例,肋软骨19例,耳甲腔软骨3例;使用漂浮/固定型移植58例,固定型移植4例,延伸型移植18例。结果：除1例出现了鼻尖突出度不足,经二次手术纠正外,余69例鼻尖成形良好,病人对手术效果满意。结论：根据不同情况,选择不同种类,不同材料进行鼻小柱支撑移植是鼻尖整形中一项良好的手术技术。     

以鼻中隔软骨为鼻小柱支撑移植物在鼻尖整形中的应用

目的:探讨以鼻中隔软骨为鼻小柱支撑移植物在东方人鼻尖整形中的应用。方法:在50例鼻尖整形患者中,均以鼻中隔软骨为鼻小柱支撑移植物,使用固定悬浮型移植27例,延伸型移植13例,鼻中隔延伸型移植10例。结果:除1例因术后鼻尖突出度不足,经二次手术纠正外,余49例鼻尖成形良好,患者对手术效果满意。结论:根据不同情况,以鼻中隔软骨的不同植入形式进行鼻小柱支撑移植是鼻尖整形中一项良好的手术技术。     

鼻尖圆钝肥大的美容整形

目的　为了改变圆钝肥大的鼻尖。方法　根据鼻尖的圆钝程度,采用内外一起,综合步骤相结合的方法即在塑造鼻尖内部软骨形态的同时,修整鼻尖部外覆的皮肤,并辅以机械磨削,人工支架,埋线塑形等手段,以纠正鼻尖的圆钝肥大。结果　自1997年以来,本组12例,经4个月～3年术后随访,获得满意效果。结论　鼻尖圆钝肥大的治疗难点主要在于鼻尖部过厚过多的皮肤组织,单纯修整鼻尖部的软骨往往收效甚微。因此,在整个治疗过程中鼻下部皮瓣的修整和塑形是手术成功的关键。     

以肋软骨皮质为鼻小柱支撑移植物在鼻尖整形中的应用

目的:探讨以肋软骨皮质作为鼻小柱支撑移植物在鼻尖整形中的应用效果.方法:2017年6月-2019年6月,应用肋软骨皮质为鼻小柱支撑移植物修复鼻尖形态126例,切取右侧第6或7肋部分软骨,再取肋软骨皮质雕刻皮质片插入鼻中隔前后角两侧,以作鼻小柱支撑移植物.根据患者鼻部情况,利用其余的肋软骨皮质或髓质塑造鼻尖形态,膨体或硅...     

唇腭裂术后鼻整形的辩证法

唇腭裂是最为常见的先天性颅面畸形。国际报道的新生儿发病率是。00794％。病因是多方面的,包括遗传、营养、致畸因子、环境因素等。临床表现多样,从单纯的唇裂,到唇部和腭部完全裂开。唇腭裂常常伴有特征性鼻部发育异常和半侧颜面发育不良。鼻部发育异常的原因可以是原发的,也可以是继发的。原发性源于内在的发育进程异常,继发性源于原有畸形的复发、瘢痕或手术后遗症。对于此类鼻畸形的治疗,需要用发展的、变化的和全面的辩证思维,以取得最佳的临床效果。     

保留性鼻整形临床研究进展及对东方人鼻整形应用的探讨

鼻整形术的发展通常与术式的创新密切相关.为了改善鼻功能和获得美学效果,近年来,保留性鼻整形术在西方鼻整形界得到了广泛应用.世界各地的整形外科医师也对保留性鼻整形的手术方法和适应证展开了广泛的探讨,特别是鼻尖和鼻背的保留问题.现对目前西方保留性鼻整形手术的临床应用进展、鼻整形手术的适应证、禁忌证及并发症作一综述,并对保留...     

亚洲人鼻形态及鼻尖整形手术的进展

鼻综合整形已经成为亚洲人鼻部整形的一个热点,结合自体软骨的解剖基础和质量基础,将手术技术灵活地结合起来,从而达到改善外观,塑造美观鼻子的效果.我们根据国内外的资料,对亚洲人鼻部的形态特点及鼻尖整形手术方法进行如下综述.     

鼻整形中若干哲学问题的思考

鼻的形态对于面部容貌的重要性,可以说是五官之首,倍受受术者和医者的重视.本专栏中的几位同道分别从不同角度进行了鼻整形的研究,笔者受邀为本专栏撰写述评,深知这是一件万难之事,一是鼻整形较复杂,其中不但蕴涵着医学、美学、心理学和哲学等问题,而且对医者的医学素养、美学素养、心理学素养和哲学素养要求较高.而自己在这些方面的素养还远远达不到;二是笔者从事鼻整形研究的时间尚短,对于鼻整形的理解,尤如管中窥豹.但遇到的情况越多,思考越多,越感觉到鼻整形太难,越觉得站在鼻整形的神圣殿堂之外,仰之弥高,望之弥坚.但另一方面,鼻整形手术的这种挑战性,也许正是其成为整形手术中最有魅力手术的原因所在.     

对当前鼻美容整形的几点思考

鼻是面部正中最突出的器官，其外形对人的容貌有较大影响，所以鼻外形有缺陷的患者非常渴望修复与改善，因此鼻美容整形一直受到医生和患者的高度重视。鼻整形技术可以追溯到公元前600年，古印度Sushruta应用面颊部皮瓣进行鼻再造，至今已有2600余年的历史。鼻美容整形经历了漫长的发展过程，     

Aesthetic Rhinoplasty of the Asian Nasal Tip: A Brief Review

Tip surgery, the most important part of the rhinoplasty procedure, has entered a new era in the past few decades. Various treatment protocols have been attempted. To date, however, opinions on the management of the Asian tip have not been solidified. To generalize and provide appropriate guidelines for the treatment of typical Asian tips, an English literature search from 1977 to March 2007 was conducted. Finally, a total of 26 papers were selected for review. The full text of each paper was read carefully, and data were extracted. Then all extracted information was imported into Microsoft Excel. Nine articles treating 11 groups of patients described the suitable techniques for Asian nasal tips, with 81.8% of the groups advocating that the protocol include a grafting technique, 64% reporting use of the grafting technique alone, and 9% applying cartilage reduction and a suturing technique. Of the 11 (18%) groups, 2 attempted more than one technique. Because of the Asian nasal tip's innate qualities, success with nasal tip plasty for Asians depends on the combined application of appropriate suturing, grafting, and defatting, with grafting techniques contributing the most.     

Complications Associated With Isotretinoin Use After Rhinoplasty

Background This study aimed to evaluate the association between the postoperative use of isotretinoin and the formation of nasal tip deformities after rhinoplasty.Methods A retrospective study investigated a case series of patients who presented with nasal tip deformities subsequent to the use of isotretinoin after rhinoplasty. Patients who had taken isotretinoin after rhinoplasty were identified from a single surgeon’s case log. Clinic charts and operative reports were reviewed. Predisposing factors and time intervals to complications were identified.Results Three patients were found to have undergone isotretinoin therapy after rhinoplasty. Nasal tip deformities included bossa formation, asymmetry, and prominence of a composite graft. All three patients required subsequent procedures to repair soft tissue nasal tip deformities. In all three cases, isotretinoin was started within 2 years of the primary rhinoplasty. The nasal tip deformities were first observed within 6 months after isotretinoin was started.Conclusions Three cases are described in which postoperative use of isotretinoin was associated with nasal tip deformities after rhinoplasty. Further studies are needed to investigate this possible causative relationship and to describe the risks involved.     

鼻整形术中应用自体耳软骨治疗鼻尖低平的效果和安全性

目的 探究鼻整形术中应用自体耳软骨治疗鼻尖低平的效果和安全性。方法 选取于河南大学附属 南阳南石医院2021年1月-2023年1月接受鼻整形手术治疗的100例患者为研究对象,以随机数字表法分为对 照组和观察组,每组50例。对照组应用膨体假体填充实施鼻整形手术治疗,观察组应用自体耳软骨实施鼻 整形手术治疗,比较两组临床疗效、鼻部形态改善情况及并发症发生率。结果 观察组临床治疗总有效率 为94.00%,高于对照组的80.00%,差异有统计学意义（ P ＜0.05）;观察组术后鼻长、鼻尖高度、鼻尖角、 鼻尖宽水平均优于对照组,差异有统计学意义（ P ＜0.05）;观察组并发症发生率为4.00%,低于对照组 的22.00%,差异有统计学意义（ P ＜0.05）。结论 鼻整形术中应用自体耳软骨治疗鼻尖低平可有效改善鼻 长、鼻尖情况,提高治疗效果,且并发症较少。     

Rhinoplasty. The Difficult Nasal Tip: Total Resection of the Alar Cartilages

There are many ways to reconstruct and make nasal tips more attractive. Sometimes we cannot find the best way unless we at least remove all surplus from the tip. This may occur in primary or secondary rhinoplasty. In principle, anything is possible when relocating and reconstructing. However, sometimes we face reality when we uncover the tip: broken or bulging cartilages that are difficult to put right. For this reason, in 1987 we thought of totally resectioning the alar cartilages in a case of secondary rhinoplasty with an unsightly appearance. After a year the result was seen to be correct from an aesthetic and a functional perspective and is still so today. Aesthetically, it kept its shape and did not collapse with nasal respiratory failure. We covered the end of the crus medialis with a small, temporary, one- to two-layered fascia patch. Except in exceptional cases, we now use this procedure: Total sectioning of the alar cartilages including the domes, or maintenance of them by preserving the fibroadipose tip tissue with a suture in the middle of the end of the crus medialis and by covering this with temporary fascia, which usually has two layers depending on the thickness of the skin of the tip. This procedure is indicated mainly in secondary rhinoplasty when the cartilages of the tip are completely destroyed, and in primary rhinoplasty when the tip is excessively wide and bulbous. Our philosophy is, therefore, elegance and beauty of the nasal tip with a solid and equilateral base without prejudices.     

Nasal Tip Plasty Using Various Techniques in Rhinoplasty

Rhinoplasty is one of the most common aesthetic surgical procedures in Korea today. However, simple augmentation rhinoplasty results often failed to satisfy the high expectations of patients. As a result, many procedures have been developed to improve the appearance of the nasal tip and nasal projection. However, the characteristics of Korean nasal tips including the bulbous appearance (attributable to the thickness of the skin), flared nostrils, and restriction of the nasal tip attributable to an underdeveloped medical crus of the alar cartilage and a short columella have made such procedures difficult. Currently, most plastic surgeons perform rhinoplasty simultaneously with various nasal tip plasty techniques to improve the surgical results. An important part of an aesthetically pleasing result is to ensure an adequate nasal tip positioned slightly higher than the proper dorsum, with the two tip defining points in close proximity to each other, giving the nose a triangular shape from the caudal view. From June 2002 to November 2003, the authors performed rhinoplasty with simultaneous nasal tip plasty using various techniques according to the tip status of 55 patients (25 deviated noses, 9 broad noses, 15 low noses, and 6 secondary cleft lip and nose deformities). The surgery included realignment of alar cartilage by resection and suture, fibroareolar and subcutaneous tissue resection, tip graft, and columellar strut. The postoperative results over an average period of 10 months were entirely satisfactory. There were no patient complaints, nor complications resulting from the procedures. Good nasal tip projection, natural columellar appearance, and improvement of the nasolabial angle were achieved for most patients. In conclusion, rhinoplasty with simultaneous nasal tip plasty, achieved by a variety of techniques according to patients tip status, is an effective method for improving the appearance of the nose and satisfying the desires of the patients.     

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。     

致密多晶羟基磷灰石微粒人工骨经鼻小柱切口隆鼻术

本文分析了５２９例鞍鼻患者采用致密多晶羟基磷灰石微粒人工骨（颗粒状ＨＡ）经鼻小柱切口隆鼻术的临床效果;获得较满意的临床效果。ＨＡ是一种比较理想的隆鼻材料但有待改进;鼻小柱切口无明显瘢痕形成,适合于采用颗粒状ＨＡ材料的隆鼻术