隆鼻术后硅胶假体外露的原因及防治

The prevention and causes of extrusion of prosthesis in augmentation rhinoplasty with silicone implant

目的:探讨硅胶假体隆鼻术后假体外露的原因及防治措施。方法:对16例鼻假体外露就医者,手术取出假体,根据假体外露部位,雕刻形态、隧道层次、切口位置等分析假体外露的原因,从而提出预防措施及提高手术效果的方法。结果:16例中,6例假体短臂由鼻小柱侧缘切口穿出,5例假体由鼻尖下点穿出(其中3例为柳叶形假体),3例由鼻前庭切口穿出,其中1例合并感染,2例经鼻背皮肤穿出。取出的假体形态:柳叶形假体雕刻太尖,L形假体短臂过长而长臂宽厚、假体叠加等。结论:假体与鼻头、鼻背不相称导致置入后张力过大或假体形状雕刻欠佳是假体外露的根本原因。因此,隆鼻术后使假体处于无张力状态以及提高假体雕刻技巧是避免假体外露的主要措施。

Objective To further investigate reasons of the extrusion augmentation rhinoplasty with silicone implant. Methods Prostheses of The shape of prostheses and layer of tunnel as well as place of incision and its prevention and treatment in extrusion were taken out by operation, in relation with surrounding pressure of prostheses were analysed. The ways and managements to improve the outcome of augmentaion rhinoplasty were presented. Results In all 16 cases,in which there were 6 （37.5%）lateral rim of columella extrusion,5 （31.3%） nose tip extrusion, 3（18.7%）vestibule extrusion including one patient companied with infection and 2（12.5%）bridge of nose extrusion. The shape of protheses sculptured,too sharp or large, width and long and overlap types and so on. Conclusion The commonest extrusion site was the incision of lateral columella, the second site was nose tip.The main reasons of extrusion were local excessive pressure and the bad sculpture of the prosthesis. Therefore. the key point a successful augmentation rhinoplasty should reduce pressure surrounding prothesis as can as possible and improve carving skills of prosthesis.