自体软骨及生物材料植入物充填单侧唇裂继发鼻畸形

Correction of secondary unilateral cleft lip nasal deformity using autologous cartilage and biomaterial implant

背景：单侧唇裂一期修复术后往往继发不同程度的鼻畸形,根据不同畸形的特点,选择合适的自体软骨及生物材料可有效加强和恢复鼻部支架结构、矫正鼻部畸形。目的：探讨不同植入材料在单侧唇裂继发鼻畸形整复中的应用及效果。方法：纳入单侧唇裂修补36例,表现为不同程度的鼻部畸形,在行唇部相关手术的同时,对移位的鼻软骨及周围软组织进行有效松解及复位,并根据不同畸形的特点,应用自体鼻中隔软骨、耳甲软骨、肋软骨及Medpor外科种植体对患侧鼻翼基底部、鼻翼软骨、前鼻棘、鼻小柱及鼻尖部进行充填以加强和恢复鼻部骨及软骨支架结构。结果与结论：所有病例鼻部畸形明显矫正,患侧鼻翼基底部抬升,双侧鼻孔、鼻穹窿部基本对称,鼻小柱延长、偏斜纠正,鼻尖部形态满意。自体软骨供区无明显畸形出现。随访1个月~3年,2例患侧鼻翼较术后塌陷、鼻翼稍低平、鼻孔略宽于健侧,其余病例鼻外形维持良好,植入物无排斥反应、移位及外露。提示,在唇裂继发鼻畸形整复手术中,应用植入材料充填可有效加强和恢复鼻部支架结构,明显改善鼻部畸形,术中应根据不同畸形的特点选择合适的植入充填材料。

BACKGROUND： Secondary different-degree nasal deformities often occur after unilateral cleft lip rhinoplasty. It is important to select the appropriate autologous cartilage and biological materials for correction of nasal deformities depending on the characteristics of deformities. OBJECTIVE： To explore the clinical methodology and effects of implants in secondary unilateral cleft lip rhinoplasty. METHODS： Thirty-six cases suffering varied secondary nasal deformities of unilateral cleft lip were treated differently according to the deformities diversification. The nasal cartilage and soft tissues were fine anatomic disconnected and reset, and the different implants, including autologous septal cartilage, auricular cartilage, costal cartilage and Medpor surgical implant, were implanted to nasal alar dome sunk, lower lateral cartilage, nasal spine, columella, tip to supply the powerful supporting strength for nasal constructions. RESULTS AND CONCLUSION： All 36 cases obtained relatively satisfactory results, including nasal alar dome sunk elevated, the nasal alar and nastrils symmetrized, the nasal columella extended and the tip raised. No obvious complications were occurred in donor cartilage sites. All cases were followed up for 1 month to 3 years, the cleft side alar of 2 cases collapsed and the nastril floor widened, the nasal contour and appearance of 34 cases were good. No rejection, displacement and exposure of implants were found. These results supported that implants could effectively enhance and rebuild the nasal supporting constructions and correct nasal deformities of unilateral cleft lip in secondary rhinoplasties. Choosing suitable implants is critical to the unilateral cleft lip rhinoplasty.