自体鼻中隔软骨-硅胶复合体移植修复单侧唇裂鼻畸形

NASAL SEPTUM CARTILAGE-SILICA GEL COMPLEX FOR REPAIRING NASAL DEFORMITIES OF UNILATERAL CLEFT LIP

目的应用自体鼻中隔软骨-硅胶复合体二期修复先天性单侧唇裂鼻畸形,评价其疗效。方法2001年6月-2007年6月,收治单侧唇裂修复术后鼻畸形伴鼻中隔偏斜患者38例。男21例,女17例;年龄14～23岁,平均17.6岁。其中左侧26例,右侧12例;完全性21例,不完全性17例。畸形主要为鼻小柱偏向健侧、鼻尖低平圆钝、鼻孔不对称及患侧鼻翼塌陷。均为二期修复。患者曾行手术1～4次,上次手术至此次手术时间3～10年,平均5.5年。术中根据鼻畸形取自体鼻中隔软骨1.8cm×1.2cm,植入鼻尖部假体表面以延长鼻小柱,抬高鼻尖,将多余的软骨植于塌陷鼻翼处,同时行鼻尖部脂肪结缔组织瓣移位,固定后将患侧鼻翼软骨和软组织复位至正常解剖位置。结果患者术后切口均Ⅰ期愈合,供软骨区无并发症发生。鼻外形美观,鼻尖高度及形态自然、双鼻孔大小基本对称,鼻小柱居中,鼻尖扁平及鼻翼塌陷均不同程度矫正,鼻唇角生理弧度恢复。38例均获随访,随访时间12～18个月,平均15.6个月。随访12个月时患者满意30例(78.9%),较满意8例(21.1%)。患者均无移植软骨移位及外露,无出血、感染等并发症,外形良好。结论应用自体鼻中隔软骨-硅胶复合体移植是修复单侧唇裂鼻畸形一种较理想的术式。

Objective To evaluate the operative methods and therapeutic effects of nasal septum cartilage-silica gel complex for two-stage repair of nasal deformities of unilateral cleft lip. Methods From June 2001 to June 2007, 38 cases of secondary nasal deformity and septum deviation of cleft lip were treated with transplanting nasal septum cartilage-silica gel complex. Among of them, there were 21 males and 17 females, aging 14-23 years with an average of 17.6 years. All cases were with nasal deformities of unilateral cleft lip, including 21 cases of complete cleft lip and 17 cases of incomplete cleft lip. The locations were left side in 26 cases and right side in 12 cases. Nasal deformities were columella nasi deflexion, flattened nasal tip, pteleorrhine and alanasi collapse. The patients received 1-4 times operations, and the interval of two operations was 3-10 years （mean 5.5 years）. According to nasal deformity, the nasal septum cartilage of 1.8 cm × 1.2 cm was cut, and transplanted into the nose point phantom surface forming ＂the shield＂ to extend nose column and to raise the tip of the nose. At the same time the nasal tip fat-connective tissue flap graft with fat knot was given. After fixation, the nasal alar cartilage and soft tissues were reduced to normal position. Results Primary healing of the incisions was achieved in all cases. The nasal deformity was corrected. The postoperative follow-up period was 12-18 months with an average of 15.6 months. All the patients of regional cartilage scars had no complication. The figure of nose was slinky, the height of apex of nose and the shape of nose was natural, the apex of nose, nasal ala, nostrils and nasal columella were satisfactory [（the results were satisfactory in 30 cases （78.9%）, general in 8 cases （21.1%）]. The nose department overall esthetics shape was improved in all the patients, no complications of the phantom sliding, shifting and exposure, hemorrhage and infection occurred. Conclusion The nasal septum cartilagesilica gel complex to repair the nasal deformities of unilateral cleft 1 i p is an ideal operation style.