肋软骨移植修复单侧唇裂术后严重鼻畸形的临床探讨

目的]探讨肋软骨移植修复单侧唇裂术后严重鼻畸形的疗效.方法]切取一段肋软骨予以修整,植入鼻小柱内,重建鼻下端的鼻小柱支架结构,并在鼻底行“y”切口,“v”缝合或“z”交叉三角瓣成形术,切开皮肤皮下组织及肌层,并尽可能复位鼻唇肌肉,再造口轮匝肌环,以缩小鼻孔、修复鼻底嵴,并纠正鼻小柱歪斜.对上颌骨发育严重缺陷,鼻翼基底部凹陷明显者,可于鼻翼基底部及鼻底嵴处填充肋软骨片,以抬高鼻翼基底部及鼻底嵴.背部低平或偏斜者形成鼻背筋膜通道,利用取出的肋软骨塑形后同时进行隆鼻术.最后,鼻小柱行“v”“y”缝合以延长鼻小柱.鼻穹隆鼻缘皮肤通过鼻内转移来实现.结果]鼻外形明显改善,患者满意度高.结论]肋软骨移植修复单侧唇裂术后严重鼻畸形疗效满意,值得临床推广应用.

Clinical Discussion on Costal Cartilage Transplantation for Repairing Severe Nasal Deformity after Unilateral Cleft Lip Surgery

Objective]To explore the efficacy of costal cartilage transplantation for repairing severe nasal deformity after unilateral cleft lip surgery.Methods] A segment of costal cartilage was carved and repaired,and then transplanted into nasal columella to reconstruct the scaffold structure of nasal columella under the nose.The ＂y＂ incision and ＂v＂ suture or ＂z＂ cross triangle flap plasty under the nose floor was performed.Subcutaneous tissue and muscular layer were incised.Musculus nasolabialis was repositioned as far as possible.Orbicularis oris muscle ring was reconstructed to constrict nostrils,repair nose floor ridge and correct the deviated nasal columella.For patients with severe maxillary hypoplasia and apparent depression of basilar part of alae nasi,costal cartilage piece could be filled in basilar part of alae nasi and nose floor ridge to elevate basilar part of alae nasi and nose floor ridge.For the patients with low and flattened or deviated nasal dorsum,nasal dorsal fascia channel was established,and the carved costal cartilage was used for plasty and rhinoplasty was done.In the end,nasal columella underwent ＂v＂ and ＂y＂ suture to extend nasal columella.The skin of nasal hump and nasal margin was repaired by intranasal transferring.Results]The appearance of the nose was improved obviously,and the satisfaction of patients was high.Conclusion]Costal cartilage transplantation for repairing severe nasal deformity after unilateral cleft lip surgery has satisfactory effect.Therefore,it is worthy of clinical promotion.