鼻综合整形的方法探讨及效果评价(1)
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[摘要]目的:探讨鼻综合整形的手术方法并评价其临床效果。方法:根据外鼻形态的具体缺陷情况,同时采用假体隆鼻、鼻头缩小、鼻翼缩小、耳软骨鼻尖延长、鼻小柱延长等多项技术中的二项以上进行鼻整形手术。结果:2007年3月～2010年4月对307例患者采用上述方法行鼻整形术,术后均获明显改善效果。随访6个月～2年,其中1例于半年后发生感染而取出鼻假体,其余就医者对效果均感满意,形态自然,切口瘢痕不明显。结论:鼻综合整形能从全方位改善外鼻不良形态从而增加鼻部整体美感。术中均衡考虑不同部位手术之间的相互影响关系,是把握手术整体成形效果的关键。
[关键词]鼻整形术;方法;效果评价
[中图分类号]R622[文献标识码]A[文章编号]1008-6455(2010)07-0949-03
Approach to comprehensive rhinoplasty and its effect evaluation
CHEN Ming-song
( Changsha Huamei Aesthetic and Plastic Hospital,Changsha 410000,Hunan,China)
Abstract:ObjectiveTo probe into the surgical methods of comprehensive rhinoplasty and evaluate the clinical effect.MethodsAccording to the specific defect of the nose, using two or more technology of nose augmentation, nasal tip reduction, alar narrowing ,apex nasi extension,columella nasi extension and so on to operate plastic surgery at the same time.Results307 cases of comprehensive rhinoplasty were performed by using the above-mentioned method from Mar. 2007 to Apr.2010. The effect is obvious and defect has been improved greatly. Duing the follow-up research for 6 months to 2 years, only one patient was infected after six months and the artificial nose had to be removed. The other patients are satisfied withthe natural shapes and the inconspicuous scars.ConclusionComprehensive rhinoplasty can omnidirectionally improve the faulty shape of the nose, and enhance theaesthetic appeal as a whole. Symmetrically considering the relationship among sub-unit operation is the key to grasping ensemble effect of rhinoplasty.
Key words:rhinoplasty; approach; effect evaluation
鼻整形术是最常见的美容外科手术之一,单纯隆鼻术仅能改善鼻额角及鼻面角,增加鼻背部的立体感,对鼻下部的缺陷难以达到改善目的,故仅对部分求美者而言获得了美容效果。笔者自2007年来对307例就医者采用鼻综合整形术,同期施行假体隆鼻、鼻头缩小、鼻翼缩小、鼻尖延长、鼻小柱延长中两个以上项目,效果令人满意,现报道如下。
1临床资料
本组307例,年龄18～34岁,以20～25岁年龄最多。其中施行隆鼻+鼻头缩小+鼻翼缩小(A组)54例,隆鼻+鼻头缩小+耳软骨鼻尖延长(B组)62例,隆鼻+鼻头缩小(C组)58例,隆鼻+耳软骨鼻尖延长(D组)83例,其它50例。
2手术方法
2.1 麻醉: 眶下孔阻滞及鼻部局部浸润麻醉,或者丙泊酚静脉给药引导下的局部浸润麻醉。
2.2手术方法
2.2.1 鼻头缩小:切口采用鼻小柱下1/3“-^-”形切开,再绕鼻小柱软骨前缘向上达鼻翼内侧面呈飞鸟状的切口,紧贴软骨面分离显露鼻翼软骨外侧角,切除外侧角头侧部分约1/3～1/2(视软骨大小强度而定)宽度,剪除鼻下部皮下过多的纤维脂肪组织,6-0尼龙线对拢缝合鼻翼软骨内外侧角交界部,最后缝合关闭切口,外以热塑板塑形固定5天,7天拆线。
2.2.2 鼻翼缩小:根据鼻翼肥大特点,设计鼻翼外侧沟,鼻翼前下部,及鼻孔底部切口线,呈三维立体状楔形切除(图1)。6-0可吸收线皮内减张缝合,7-0尼龙线间断缝合切口。
2.2.3 耳软骨鼻尖延长:先据外鼻形态修雕好硅胶假体,于耳甲腔内切取约10mm×25mm软骨一块,做成直径约8mm的2～3层软骨垫,以6-0尼龙线缝合固定在L形假体长短臂交界部,注意软骨垫的朝向角度与原鼻尖最短缩处相吻合,这样以硅胶假体为支撑,软骨垫与鼻尖皮肤相接触,可将鼻尖撑起延长。
2.2.4鼻小柱延长:于鼻小柱基底正中设计“V”形切口,再绕鼻小柱软骨前缘向上达鼻翼内侧面呈飞鸟状的切开,完成鼻部其它手术项目准备缝合切口时,基底部行V-Y推进缝合,可推进2～4mm ......
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