上颌骨额突区骨折继发鼻面部畸形手术整复效果评估

Evaluation of the results of surgical revision of nasofacial deformities secondary to fractures of the frontal process of the maxilla

目的评估上颌骨额突区骨折继发鼻面部畸形的手术整复效果。方法回顾性分析2009年1月至2020年12月上海交通大学医学院附属第九人民医院耳鼻咽喉头颈外科手术处理的上颌骨额突区骨折继发鼻面部畸形患者的临床资料。采用切开复位内固定术、鼻中隔矫正术、眼眶壁骨折整复术等对鼻面部畸形进行手术治疗。术后3个月,从以下3个方面对手术效果进行评估:(1)鼻面部形态,由2位医生和患者进行评估,分为非常满意、满意和不满意3个级别。(2)鼻腔通气功能客观评估,采用鼻声反射仪和鼻阻力仪进行检测,包括鼻腔最小截面积(MCA)、距前鼻孔7 cm的鼻腔容积(NV)、鼻腔吸气总阻力(TRi)和鼻腔呼气总阻力(TRe)。为了消除鼻黏膜肿胀带来的差异,按照外伤后至术前检查的时间将患者分为<7 d、7~14 d、>14 d 3组分别进行术前后比较。(3)鼻腔通气功能主观评估,采用鼻腔阻塞症状评估(NOSE)量表进行评分,总分为0~20分,分数越高鼻阻塞症状越重。采用SPSS 17.0软件进行统计分析,计量资料以±s表示,术前和术后3个月数据比较采用配对t检验,P<0.05表示差异有统计学意义。结果共纳入83例患者,男53例,女30例;年龄7~78岁,中位数为35岁。所有患者均成功完成手术,术后软组织切口均愈合良好,鼻面部形态得到改善。术后3个月,医生对鼻面部形态表示非常满意和满意的患者分别为49例(59%)和34例(41%),自评为非常满意、满意和不满意的患者分别有51例(61%)、29例(35%)、3例(4%)。术前<7 d(14例)、7~14 d(28例)、>14 d(41例)组MCA分别为(0.43±0.10)cm^(2)、(0.51±0.15)cm^(2)、(0.50±0.14)cm^(2),NV分别为(9.76±2.20)cm^(3)、(12.40±4.15)cm^(3)、(12.40±3.87)cm^(3),TRi分别为(1.93±0.28)kPa·L^(-1)·s^(-1)、(1.96±0.24)kPa·L^(-1)·s^(-1)、(1.96±0.23)kPa·L^(-1)·s^(-1),TRe分别为(2.02±0.35)kPa·L^(-1)·s^(-1)、(2.08±0.38)kPa·L^(-1)·s^(-1)、(2.08±0.34)kPa·L^(-1)·s^(-1);术后3个月,3组MCA分别为(0.48±0.08)cm^(2)、(0.56±0.15)cm^(2)、(0.56±0.14)cm^(2),NV分别为(11.56±2.49)cm^(3)、(14.40±4.50)cm^(3)、(14.41±4.24)cm^(3),TRi分别为(1.74±0.19)kPa·L^(-1)·s^(-1)、(1.78±0.15)kPa·L^(-1)·s^(-1)、(1.78±0.14)kPa·L^(-1)·s^(-1),TRe分别为(1.73±0.24)kPa·L^(-1)·s^(-1)、(1.79±0.24)kPa·L^(-1)·s^(-1)、(1.79±0.22)kPa·L^(-1)·s^(-1)。3组术后3个月MCA、NV均大于术前(P均<0.01),TRe、TRi均小于术前(P均<0.01)。术后3个月,NOSE量表评分为(4.1±1.2)分,显著低于术前的(10.5±1.8)分(P<0.01)。结论客观与主观相结合的评估方法有助于医生术前准确判断上颌骨额突区骨折所造成的鼻面部形态和功能上的缺陷,制定完善的手术计划,患者在行骨折整复术后鼻面部外观和鼻腔通气功能都得到了明显改善。

Objective To evaluate the effect of surgical revision of nasofacial deformity secondary to maxillary frontal process fracture.Methods The clinical data of patients with nasofacial deformities secondary to maxillary frontal process fractures who underwent surgery in the Department of Otolaryngology,Head and Neck Surgery of Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2009 to December 2020 were retrospectively analyzed.The nasofacial deformity was surgically treated by open reduction with internal fixation,nasal septum correction,and reconstruction of orbital wall fracture.Three months after surgery,the surgical results were evaluated from the following three aspects.(1)Nasofacial morphology,which was evaluated by two doctors and the patient,and was classified into 3 levels:very satisfied,satisfied,and unsatisfied.(2)Objective assessment of nasal ventilation function,which was measured by nasal acoustic rhinometry and nasal resistance detection,including measurements of nasal minimum cross-sectional area(MCA),nasal volume 7 cm from the anterior nostril(NV),total nasal inspiratory resistance(TRi)and total nasal expiratory resistance(TRe).To eliminate the differences caused by swelling of the nasal mucosa,the patients were divided into 3 groups of<7 d,7-14 d,and>14 d according to the time from trauma to preoperative examination for pre-and post-operative comparisons,respectively.(3)Subjective assessment of nasal ventilation function was performed using the nasal obstructive symptom evaluation(NOSE)scale,with a total score of 0 to 20,with a higher score indicating more severe nasal obstruction symptoms.The SPSS 17.0 software was used for statistical analysis,and the measurement data were expressed as Mean±SD.A paired t-test was used to compare the preoperative and 3-month postoperative data,with P<0.05 indicating a statistically significant difference.Results A total of 83 patients were included,53 males and 30 females,aged 7 to 78 years,with a median of 35 years.All patients underwent successful surgery,and all soft tissue incisions healed well after surgery with improved nasofacial morphology.Three months after surgery,the physicians were very satisfied and satisfied with the nasofacial morphology in 49(59%)and 34(41%)patients,respectively,and patients were very satisfied,satisfied,and unsatisfied in 51(61%),29(35%),and 3(4%)cases,respectively.Before surgery,the<7 d group(14 cases),7-14 d group(28 cases),and>14 d group(41 cases)had MCA values of(0.43±0.10)cm^(2),(0.51±0.15)cm^(2),and(0.50±0.14)cm^(2);NV values of(9.76±2.20)cm^(3),(12.40±4.15)cm^(3),and(12.40±3.87)cm^(3);TRi values of(1.93±0.28)kPa·L^(-1)·s^(-1),(1.96±0.24)kPa·L^(-1)·s^(-1),and(1.96±0.23)kPa·L^(-1)·s^(-1);TRe values of(2.02±0.35)kPa·L^(-1)·s^(-1),(2.08±0.38)kPa·L^(-1)·s^(-1),and(2.08±0.34)kPa·L^(-1)·s^(-1),respectively.Three months after surgery,in the three groups,the MCA values were(0.48±0.08)cm^(2),(0.56±0.15)cm^(2),and(0.56±0.14)cm^(2);the NV values were(11.56±2.49)cm^(3),(14.40±4.50)cm^(3),and(14.41±4.24)cm^(3);the TRi values were(1.74±0.19)kPa·L^(-1)·s^(-1),(1.78±0.15)kPa·L^(-1)·s^(-1),(1.78±0.14)kPa·L^(-1)·s^(-1);the TRe values were(1.73±0.24)kPa·L^(-1)·s^(-1),(1.79±0.24)kPa·L^(-1)·s^(-1),and(1.79±0.22)kPa·L^(-1)·s^(-1),respectively.In all three groups,the MCA and NV values at 3 months postoperatively were greater than the preoperative values of MCA and NV(all P<0.01),and the TRe and TRi values at 3 months postoperatively were less than those preoperative values(all P<0.01).At 3 months postoperatively,the NOSE scale score was(4.1±1.2)points,which was significantly lower than the preoperative score of NOSE scale score[(10.5±1.8)points](P<0.01).Conclusion The combination of objective and subjective assessment method can help the surgeon to accurately determine the nasofacial morphological and functional defects caused by the fracture of the maxillary frontal process area before surgery and to formulate a perfect surgical plan.The patients’nasofacial appearance and nasal ventilation functions were significantly improved after the fracture revision surgery.