直视下自体软骨-硅胶复合体移植重塑鼻外形

COMPLEX OF AUTO-CARTILAGE GRAFTING AND SILICONE IMPLANT FOR OPEN NASAL PLASTY

目的总结应用软骨修整及软组织修剪联合自体软骨-硅胶复合体移植重塑鼻外形的手术方法及效果。方法 2006年5月-2008年7月,对36例鼻外形不良患者采用鼻尖皮下软组织修剪、鼻翼软骨修整、自体软骨移植及软骨-硅胶复合体植入重塑鼻外形。其中男3例,女33例;年龄18～36岁,平均23岁。鼻尖肥大、圆钝20例,鼻尖低平10例,鼻孔轻度外露2例,整个外鼻偏小伴鼻尖相对肥大4例。其中8例为二次手术。结果患者术后切口均Ⅰ期愈合,软骨供区无变形。鼻尖外形精巧、结构清晰、颜色及手感满意,无假体外露、鼻尖皮肤发红等并发症发生。术后3～5个月,移植组织部分吸收回缩后鼻尖外形良好。术后32例获随访,随访时间3～12个月,平均6个月,鼻尖矫正度3～8mm,平均5mm,患者对鼻外形满意。结论软骨修整及软组织修剪联合自体软骨-硅胶复合体移植鼻整形术对鼻尖低平、肥大、圆钝、短鼻等手术效果肯定,手术操作简便,术后鼻外形满意。

Objective To investigate the surgical methods and outcome of reshaping the nose by using autologous cartilage grafting-silicone gel complex combined with trimming the lower lateral cartilages and thinning the superfluous tissue of the tip.Methods Between May 2006 and July 2008,36 patients with ugly nose shape received open nasal plasty by thinning the superfluous tissue and trimming the lower lateral cartilages combined with implant of auto-cartilage and silicone gel complex.There were 3 males and 33 females with an average age of 23 years（range,18-36 years）,including 20 cases of hypertrophy and obtuse round of nasal tip,10 cases of flat of nasal tip,2 cases of slight nostril exposure,and 4 cases of small whole nose with hypertrophy of nasal tip.Among them,8 cases received 2-time operations.Results All incisions achieved healing by first intention.No deformation and complication occurred at donor sites of cartilage.The appearance,contour,color,and touch sensation of the nose were satisfactory and no complications of prosthesis exposure and skin redness of the nasal tip occurred.At 3-5 months after operation,the appearance of the nasal tip was satisfactory when part of the soft tissue was absorbed.Thirty-two patients were followed up 3-12 months（6 months on average）,who were satisfied with the appearance of nose with good correct rate.Conclusion Nasal plasty by using auto-cartilage grafting and silicone implant combined with trimming the lower lateral cartilages and thinning the superfluous tissue of the tip is an effective method especially for round or bulbous nasal tip.