18例鼻中隔偏曲伴外鼻畸形临床诊疗体会

目的 探讨鼻中隔偏曲合并外鼻畸形的解剖学形成特点，总结分析同期行鼻中隔偏曲矫正和外鼻畸形整复手术方法。方法 回顾性分析2016年3月—2019年3月收治的18例鼻中隔偏曲矫正同期外鼻畸形整复患者的临床资料，其中大翼软骨发育异常11例，鼻中隔软骨尾侧端畸形5例，上颌骨鼻棘畸形2例，所有患者均先行鼻中隔偏曲矫正术；并针对不同类型的畸形结构特征单独或同时使用了缝合矫形、切除矫形和支撑矫形方法。所有患者术后随访1年以上，比较手术前后患者的鼻腔通气功能和外鼻形态视觉模拟量表(VAS)评分。结果 术后1年鼻腔通气功能和外鼻形态VAS量表评分明显低于术前，术后1年双侧鼻腔总阻力明显低于术前，差异均具有统计学意义(P均<0.05)。18例患者鼻内镜检查、鼻腔鼻窦CT显示术后鼻中隔偏曲与外鼻畸形形态改善明显。结论 总结了鼻中隔偏曲并外鼻畸形的解剖学构成分类和常用手术方法体会，为临床工作中兼顾鼻腔功能与美学的治疗策略提供参考。

Clinical diagnosis and treatment of nasal septum deviation with external nasal deformity in 18 cases

Objective To explore the anatomic characteristics of nasal septum deviation with external nasal deformity, and to summarize and analyze the surgical methods of nasal septum deviation correction and external nasal deformity restoration at the same time.Methods Clinical data of 18 patients undergoing nasal septum deviation correction and external nasal deformity reduction simultaneously from March 2016 to March 2019 were retrospectively analyzed. The deformity included pterygoid cartilage dysplasia (n=11), nasal septum cartilage caudal deformity(n=5), maxillary nasal spine deformity(n=2). All patients were treated with nasal septum deviation correction first, and suture, resection and support orthopedics were then performed alone or simultaneously according to the structural characteristics of different types of deformities. All patients were followed up for more than one year after operation, and visual analogue scale (VAS) scores of the nasal ventilation function and external nasal morphology before and after operation were compared.Results The VAS scores of nasal ventilation function and external nasal morphology one year after operation were significantly lower than those before operation, and the total resistance of bilateral nasal cavity after operation was also significantly lower than that before operation (P<0.05). Nasal endoscopy and computerized tomography of nasal cavity and paranasal sinuses revealed significant improvement of the deviation of nasal septum and the morphology of external nasal deformity in all 18 patients.Conclusion By summarizing the anatomical classification of nasal septum deviation and external nasal deformity and the experience of common surgical methods, a reference is provided for the treatment strategy of giving consideration to nasal function and aesthetics in clinical practice.