鼻尖上旋畸形的整形治疗

Correction of over rotation of nasal tip

目的探讨鼻整形术中鼻尖上旋畸形的安全有效矫正方法。方法11例原发性鼻尖上旋畸形及5例继发性鼻尖上旋畸形均采用自体耳软骨移植或与多孔高密度聚乙烯（Medpor）置入相结合的方法，重建鼻下部的支撑结构，使鼻尖获得足够的向前下方的支撑力，增加鼻尖高度及纠正鼻尖上旋，同时行“盾牌状”、“帽状”移植，以进一步上旋及突出鼻尖的形态，对于鼻尖过低者结合应用穹窿部垂直切断术。结果16例受术者术后形态满意，鼻尖上旋纠正，鼻唇角基本正常，随访6个月至1年，鼻尖部形态稳定，无并发症发生。结论鼻尖上旋畸形的纠正需要强有力的向前与向下方的支撑力，需要重建鼻下部的支撑结构，才能得到安全与有效的矫正，适量的软骨移植可进一步提高矫治效果。

Objective To investigate a safe and effective method to correct the over rotation of nasal tip in rhinoplasty. Methods 16 cases, including 11 of primary and 5 of secondary over rotation of nasal tip, were corrected with strut grafts using autologous cartilage or combined with Medpor to reconstruct the supporting structures underneath to improve the upward and forward strength of the nasal tip in order to increase the nasal height and to correct the over rotation of of nasal tip. The shield and cap grafts were also used for the patients whose nasal tip were too low, with vertical dome division technique. Results 16 cases were corrected satisfactorily, the nasal lip angles were normal and there were no complications by follow-up from 6 months to 1 year. Conclusion It is necessary to provide powerful forward and upward strength to correct the over rotation of nasal tip effectively and safely, and proper cartilage grafts can improve the height of the nasal tip and correct the over rotation of the nasal tip further.