鼻中隔两侧软骨嵌插移植和鼻小柱支撑移植短鼻延长术

Lengthening the short nose with bilateral septal spreader graft and columellar strut

目的探讨短鼻延长的安全有效方法。方法采用自体鼻中隔两侧软骨嵌插移植和鼻小柱支撑的方法重建鼻下部的支撑结构，使鼻尖获得足够向前下方的支撑力，增加了鼻背长度，同时行软骨“盾牌状”、“帽状”移植，以进一步突出鼻尖的形态。结果39例短鼻受术者对术后形态满意，鼻背延长，鼻尖上旋纠正，鼻唇角正常。随访6个月至1年，鼻背长度及形态稳定，但是有2例鼻尖部移植软骨突显，并无其他并发症发生。结论短鼻延长需要重建鼻下部的支撑结构才能得到有效矫正。鼻中隔两侧软骨嵌插扩展移植可提供强有力的向前与向下方的鼻尖支撑力。“盾牌状”、“帽状”软骨移植町进一步提高矫治效果。

Objective To investigate a safe and effective method of lengthening the short nose. Methods Thirty-nine cases of short nose were corrected by the bilateral septal spreader graft and col-urnellar strut using autologous cartilage, combined with expanded polytetrafluoroethylene （e PTFE） to reconstruct the supporting structures to improve the forward and upward strength of the nasal tip in order to increase the nasal length and to correct the over rotation of nasal tip. The shield and cap grafts were also used for the patients whose nasal tip were too low with vertical dome division tech-nique. Results All the patients showed preserved nasal length after surgery with well-proportioned nasal features and the nasal lip angles were normal. There was no evidence of postoperative nasal shortening. No operative or postoperative complications were observed by follow-up for 6 months to 1 year, except for 2 cases with graft cartilage being apparent on nasal tip. All the patients were satisfied with the surgical results achieved. Conclusions It is necessary to provide powerful forward and up ward strength to lengthen nose and correct the over rotation of nasal tip effectively and safely. The ap- plication of bilateral septal spreader graft and columellar strut using autologous cartilage and combined with e-PTFE represents a valuable tool for the short nose and proper cartilage grafts of nasal tip can improve the height of the nasal tip and further correct the over rotation of the nasal tip.