单侧完全性唇裂术后鼻唇畸形的修复(1)
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[摘要]目的:介绍一种综合术式一次性整复单侧完全性唇裂术后鼻唇畸形的方法。方法:采用一针法鼻小柱鼻翼脚复位固定,以缩窄和平齐鼻底;利用埋没导引针修复鼻翼软骨复位,改善鼻孔形状;带侧翼鼻假体隆鼻突出鼻部和加高鼻翼;上唇M瓣成形修整唇红缘重建唇弓;两红唇瓣覆盖修复红唇部等。结果:单侧完全性唇裂术后继发鼻唇畸形32例,随访20例6个月～2年,外观和效果满意。结论:应用埋线法修复鼻小柱、鼻翼脚、鼻翼软骨复位,M成形术和两红唇瓣覆盖修复红唇部等术式是值得推荐的一次性整体修复继发鼻唇畸形的方法。
[关键词]鼻畸形;获得性;唇裂;并发症
[中图分类号]R782 [文献标识码]A [文章编号]1008-6455(2010)07-0991-03
Repair of nasal deformities secondary to the surgery for unilateral complete cleft lip
WANG Cheng-yi1,WAGN Li-qiong1,ZHANG Jing-de2
(1.Department of Medical and Aesthetic,Bayannaoer City Hospital,Inner Mongolia 015000,China;2.Department of Plastic Surgery,Shanghai Changhai Hospital)
Abstract:ObjectiveThis paper aims to report a comprehensive surgical method to one time repair nasal and labial deformity secondary to operation for unilateral complete cleft lip.MethodsTo narrow and level nasal base,nasal columella and the foot of nasal ala were repositioned and fixed with one stitch method; To improve nostril shape,nasal alar cartilage was repaired and reset with the help of buried guiding needle; Rhinoplasty using nasal implant with lateral wings was performed to highlight nasal shape and to elevate nasal ala;M flap in the upper lip could restore vermilion edge and labial arch;Two vermilion flaps were adopted to cover and repair vermilion. Results Among total 32 cases of nasal deformity secondary to operation for unilateral complete cleft lip,20 cases have got satisfied appearance and effects upon follow-ups lasting 6 months to 2 years.Conclusion Buried thread method,which could be adopted to repair and reset nasal columella,the foot of nasal ala and nasal alar cartilage,"M" reshaping and two vermilion flaps,for covering and restoring vermilion, are recommended for one time complete repair of secondary nasal and labial deformity.
Key words:nasal deformity;acquired;cleft lip;complication
虽然I期唇裂修复术可以恢复满意的唇部外形,但由于修复时患儿太小标志识别失误、操作不当、先天性的鼻软骨发育异常、肌动力平衡失调和颌骨发育异常等诸多原发和继发因素的影响,术后随患者生长发育不可避免地导致鼻唇继发畸形[1]。而这种畸形的发生率甚高,据报道国外约为35%[2],国内高达84%[3],且畸形的种类和程度也各不相同,完美的修复有一定困难。与单侧唇裂Ⅰ期修复术相比,II期修复术更为多样化和复杂化[4-6],目前尚无统一标准方法。我科自2006～2010年应用一针法鼻小柱鼻翼脚复位加埋没导引针修复鼻翼软骨复位,M成形术和两红唇瓣覆盖修复红唇部等综合方法整体一次性矫正鼻唇畸形共32例效果满意,现介绍如下。
1资料和方法
1.1临床资料:本组32例(男19例,女13例)单侧完全性唇裂术后继发鼻唇畸形患者,年龄15～26岁。Ⅰ期修复时间为3个月～18岁,Ⅰ期修复术后均有不同程度的鼻小柱偏斜、鼻翼扁平、穹隆塌陷、鼻孔宽大鼻翼脚错位、上唇瘢痕、唇红缘不齐唇弓移位、唇红不对称伴中央凹陷、缺损或红唇短薄 ......
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