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。

Rhinoplasty in the patients with hypertelorism

Objective A series of 59 patients with hypertelorism were treated from 1977 to 1998 in our department. This paper discusses the methods of rhinoplasty for these patients. Methods A V-shaped or midline incision was made on the nasal dorsum or extending to the forehead. The bone between the orbitals was resected to narrow the nasal bridge. The V-flap of nasal dorsum was advanced downwards to lengthen the nose. If the lower portion of the nose as a whole was downward displaced and formed a defect of nasal lining, the nasal periosteum was used to repair it. Autogenous costal bone and cartilage were ideal implant materials. The bone and cartilage were implanted under periosteum and fixed with stainless wire or a titanic screw at the dorsum.However, the complicated cases usually required a L-shaped framework to support the collapsed nasal tip. Results In this group, the noses were narrowed 2 cm, lengthened 0.8cm and heightened 0.6 cm in average. 16 cases had the second operation for scar revision. There was no infection, osteonecrosis or implant extrusion.Conclusions Almost every case with hypertelorism presents nasal deformity and rhinoplastic procedure can be performed at one stage. The nose can be lengthened using a "V-Y" plasty as well as nasal periosteum. Costal bone is an ideal implant material.