开放式唇裂继发鼻畸形整形术(1)
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[摘要]目的：探讨单侧唇裂继发鼻畸形的手术治疗。方法：应用跨鼻小柱的鼻翼软骨下缘切口开放式鼻整形进行唇裂继发鼻畸形矫正，鼻小柱侧缘切口继续向下延伸至鼻小柱基底，将鼻小柱基部皮肤向下翻开，充分松解和暴露鼻翼软骨，矫正中隔畸形，将鼻翼软骨向前上内侧复位，与健侧鼻翼软骨、鼻背侧软骨缝合固定，必要时进行切取鼻中隔软骨移植以抬高鼻尖以及加强鼻穹窿。结果：应用本方法治疗单侧唇裂继发鼻畸形47例，单纯进行鼻畸形矫正者11例，同时行唇畸形整形者36例，效果满意，其中有32例进行了6～24个月的随访，平均随访时间为11个月，鼻外形良好。 结论：应用开放式鼻整形技术进行唇裂继发鼻畸形矫正，可在直视下充分松解并显露鼻翼软骨，准确复位及缝合固定，术后效果稳定，切口无明显瘢痕。
[关键词]唇裂；鼻畸形；鼻整形
[中图分类号]R765.9 [文献标识码]A [文章编号]1008-6455(2011)02-0212-02
Correction of the nasal deformity of unilateral cleft lip with open rhinolasty
YE Gen-rong,LIU Yu-sheng, LI De-yan,LIU Xiao-rong,GAO Yan,CHEN Ke-qiong,HUANG Wei-long
(1.Department of Pediatric Surgery,2.Department of Plastic Surgery,The People's Hospital of Dongguan City,Dongguan 523018,Guangdong,China)
Abstract:ObjectiveTo investigate a procedure for correction of the secondary deformity of unilateral cleft lip nose.MethodsThe deformity of the cleft lip nose was corrected by open rhinoplasty procedures. Restoration of the alar cartilage can be easily achieved through cross columella incision of open nasal plasty procedures. The incision of para-columella can be extended to columella base for more convenience of exposure and division and restoration of the alar cartilage. Then, the cleft side alar cartilage was sutured to that of non cleft side and upper lateral cartilages. Septal cartilage grafts may be necessary in case of correction of deviation of septum and low tip deformities.ResultsSince Jul.2007 to Jul. 2010, 47 noses of unilateral cleft lip were treated by open rhinoplasy procedure with all satisfactory results, 32 cases of whom had been followed up for 6～24 months showed no complications.ConclusionOpen rhinoplasty is an ideal procedure for correction the cleft lip nasal deformities because of its more convenient manipulation under naked eyes, more satisfied results and non evident scars.
Key words:cleft lip;nasal deformity;nasal plasty
唇裂继发鼻畸形的整形是唇腭裂治疗中最棘手的课题，在唇裂修复过程中鼻畸形的矫正要比唇畸形的矫正困难得多，特别是单侧唇裂继发鼻畸形。尽管多年来人们尝试并发展了各种不胜枚举手术技术改进，但是唇裂继发鼻畸形的矫正仍不能令人满意[1-3]。自2006年7月至2010年7月作者应用开放式鼻整形进行唇裂继发鼻畸形整形术取得了较好的临床效果，现报道如下。
1临床资料
本组应用开放式鼻整形手术治疗单侧唇裂继发鼻畸形47例，男22例，女25例；年龄12～33岁，平均16.5岁；左侧19例，右侧28例。其中单纯进行鼻畸形矫正者11例，同时进行唇畸形整形者36例。术后5～7天拆现，无切口感染或复裂等并发症，效果满意。其中有32例进行了6～24个月的随访，平均随访时间为11个月，鼻外形良好。如图1～4所示，患者术后鼻尖、鼻翼及鼻孔形态和对称性明显改善。
2手术方法
2.1 手术切口：沿双侧鼻翼软骨下缘切口切开鼻前庭皮肤 ......
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