先天性面中裂鼻畸形的整复

Rhinoplasty in patients with middle facial cleft

目的 回顾性总结５１ 例面中裂鼻成形术的治疗经验，探讨面中裂鼻畸形整复的方法。方法 病情严重者经颅采用冠状切口，眶间鼻部截骨缩窄鼻宽度。轻中度者鼻背部正中“Ｖ”形切口，部分采用垂直切口。面裂鼻尖缺失者，鼻背皮肤“Ｖ－ Ｙ”向下推进延长鼻梁，严重者整个鼻下部向下推进，鼻背部骨膜下移修复鼻腔衬里缺损。鼻支架发育不全可植入自体骨填高鼻梁，鼻小柱短小者植入物修成“Ｌ”形。植骨用螺钉或钢丝结扎固定。结果 本组病例鼻梁宽度平均缩窄２ ｃｍ ，鼻深增高０．６５ ｃｍ ，鼻长度延长０．７ ｃｍ ，有２ 例由于鼻梁低平患者行Ⅱ期再植骨术。无植骨感染坏死、外露排出并发症。结论 面裂鼻畸形，可行一期鼻成形术。鼻背皮肤“Ｖ－ Ｙ”向下推进可有效地延长鼻梁，鼻背部骨膜向下推移可修复鼻腔衬里缺损，采用肋骨填高鼻梁较为理想。

Objective 51 patients with middle facial cleft were operated from 1977 to 1998 in our department. This paper mainly discussed the methods of rhinoplasty. Methods V shaped or midline sagittal incision was made on the nasal dorsum including the forehead. The bone between the orbitals were resected to narrow the nasal bridge. “V” flap of nasal dorsum and advanced downwards to lengthen the nose. If the lower portion of the nose as a whole was downward displaced and formed a defect of nasal lining, it can be repaired with nasal periosteum. Autogenous costal bone and cartilage are ideal implant materials. The bone and cartilage were implanted under periosteum and fixed with stainless wire or a titanic screw at the dorsum. However, the complicated cases usually require a L shaped framework to support the collapsed tip. Results In this group, the noses were narrowed 2 cm, lengthened 0.7 cm and heightened 0.65 cm. 5 cases accepted second operation because of presence of scar. There was no infection, osteonecrosis or extrusion. Conclusions Rhinoplastic procedure can be performed in one stage in the patients with middle facial cleft. The nose can be lengthened using “V-Y” plasty as well as nasal periosteum and costal bone is an ideal implant material.(Shanghai Med J, 2000,23∶96 98)