牙槽裂植骨同期鼻中隔骨支架植入鼻整形术

目的　研究在牙槽裂植骨修复的同时 ,利用自体髂骨皮质板块 ,修复单侧唇腭裂鼻畸形。方法　 10岁以后的单侧完全性唇腭裂患者 ,采用自体髂骨松质骨移植修复牙槽裂 ,同时采取髂骨内侧骨皮质修整后植入两侧鼻翼软骨内侧脚之间 ,形成鼻中隔前下部的骨性基础支架 ,将分离复位的鼻翼软骨内侧脚提升 ,使软骨穹窿顶超过骨性支架的上缘约 3mm ,将软骨缝合固定于骨性支架。结果　本组 2 4例患者均一期痊愈出院 ,患侧鼻翼基部凹陷、鼻小柱偏斜、鼻尖低平等畸形得到良好的矫正。结论　牙槽裂植骨与鼻畸形整复同期进行互不干扰。鼻中隔前骨性支架对鼻的外形结构有良好的支持作用 ,可以有效地矫正唇腭裂鼻畸形 ;与牙槽裂植骨同期进行 ,取材方便 ,减少了手术及麻醉的次数。

Septum strut implantation for rhinoplasty simultaneous with cleft alveolar bone grafting in cleft lip and palate patients

Objective To pursue a more efficient and effective treatment for cleft lip and palate deformities. Methods Patients with unilateral complete cleft lip and palate at their age of 9 years after were chosen for simultaneous cleft alveolar repair and nasal deformity correction. Muco-periosteal pocket and iliacgranular bone was prepared, and bone grafting was performed conventionally. At the same time of iliac cancellous bone harvesting, a cortical plate was taken and sculpted into a strut of 18 mm in length, 6 mm in width, and 1.5 mm in thickness. A flying bird incision was made at the alar ram and across columella in a V-shape. Then the alar cartilage was detached from the overlying skin, a socket was made at the site of anterior nasal spine. The strut was inserted into the socket between the two medial crura of the alar cartilage. The medial crura was lift 3 mm above the superior edge of the strut, and mattress suture technique was used to secure the bilateral medial crura to the strut graft. Results 24 patients were treated by this technique. All the patients healed uneventfully. Depressed alar base, tilted columella and lower nasal tip were corrected satisfactorily. Conclusion There is no interference in simultaneous cleft alveolar bone grafting and rhinoplasty. Septum strut can provide favorable support for tilted nasal structure and satisfactorily correct nasal deformities. Simultaneous with alveolar grafting, it is much easier in harvesting, and the time of anesthesia and operation is also decreased.