单侧唇裂术后鼻畸形整复方法的探讨

目的：对38例单侧唇裂术后鼻畸形患者实施整复治疗的临床资料进行回顾性分析,以寻求成熟且效果肯定的手术方式。方法：以38例单侧唇裂术后鼻畸形患者为研究对象,男21例,女17例,年龄17～34岁,平均20．8岁。针对不同的畸形程度,采用悬吊或充填患侧鼻翼,纠正塌陷畸形；对严重的鼻中隔软骨偏斜患者,通过手术矫正不对称畸形和改善鼻通气,并以生物材料或软组织充填鼻翼基底,弥补患侧上颌骨发育不足；解剖复位鼻唇肌,以保持两侧肌张力的均衡。术后制作塑料鼻塞,保持2～3个月。结果：术后38例患者的鼻畸形均得到不同程度的改善,随访27例(71．05%),随访时间3个月～1a,5例患者有复发倾向；11例植入生物材料的患者,均未发生材料的排异反应。结论：单侧唇裂继发鼻畸形的病因复杂,可通过对骨、鼻软骨、鼻唇组织等多方面的矫正,有效地改善畸形；而鼻唇肌的复位,对防治术后复发十分重要。

Correction of secondary nasal deformities in unilateral cleft lip: Report of 38 consecutive cases

PURPOSE:This study was designed to find the effective and reliable methods to correct secondary nasal deformities in unilateral cleft lip by review of clinical data of 38 patients.METHODS:38 patients(21 males,17 females, ranged from 17 to 34 years in age with mean age of 20.8 years) with nasal deformities in unilateral cleft lip were available for this study.The methods used for correction included :suspension or filling of the alar cartilages to correct the collapse deformities,correction of the severe septal deviations to improve the narial figure and airway obstruction,augmentation of the alar base to obtain bilateral symmetry with biomaterial or soft tissue,anatomic reposition of nasal-labial muscles which keep the balance of bilateral tension of muscles,etc.After operations,all patients had plastic stopple for two or three months.RESULTS:The nasal deformities of 38 patients were improved more or less after operations.27 cases (71.05%) were followed up for 3 months to 1 year and the results showed deformities in 5 cases trended to relapse,11 cases undergoing biomaterial implants had satisfied results without complications.CONCLUSIONS:The cause of secondary unilateral cleft lip nasal deformities was complex.The study indicated a significant improvement by synthetically correction of deformities of bone,cartilage and soft tissues,and the restoration of the nasal-labial muscles was more important to avoid relapse.Supported by Shanghai Leading Academic Discipline Project(Grant No.Y0203).