切取鼻中隔软骨固定硅胶假体的鼻延长术

Lengthening rhinoplasty:septal cartilage graft for stabilization of the silicone implant

目的:在采用硅胶假体的鼻延长术中,由于被向尾端牵拉的,就医者原有的软骨结构和皮肤软组织存在着保持其原始位置的倾向,由此产生高张力退缩,致使硅胶植入物向头端移位。针对这个问题,采用以下方法来达到固定硅胶鼻假体使其不发生术后移位的目的。方法:取就医者鼻中隔软骨,将其一端插入硅胶假体鼻尖部缝合固定,另一端则缝合固定于保留的鼻中隔软骨垂直部。彻底松解双侧鼻翼软骨基底部,打断其与侧鼻软骨间的纤维连接,使双侧鼻翼软骨能充分向尾侧端旋转,从而使其穹窿部能覆盖硅胶-中隔软骨复合移植物尾端突出处。结果:17例要求隆鼻及鼻延长手术就医者,术后平均随访时间为9.3个月。通过术前及术后鼻唇角(NLA)的改变作为评估的客观指标,术前NLA为105.4°±5.0°,术后为94.7°±2.6°,术后NLA平均降低10.7°±3.5°,前后有显著改变(P<0.0001)。结论:此技术以就医者少量的自体鼻中隔软骨为媒介固定硅胶假体,从而能有效对抗鼻延长术中产生的,原有软骨结构及皮肤软组织向头端的退缩力。

Objective In lengthening rhinoplasty with silicone implant in East Asian,cephalic movement of the implant might took place after operation because,the implant always could not withstand the retracting tension generated by the caudally stretched lower lateral cartilage（LLC）and soft tissue skin envelope（STSE）.An operation method was presented to make the silicone implant stable. Methods A silicone implant was prepared and sculptured with a proper length longer than the length for normal augmentation and,with this length,the nasolabial angle（NLA）could be reduced to〈95° .Via trans-columella and infracartilaginous incision and approach,skin soft tissue was undermined widely.With complete resection of the fibrous attachment between the upper and lower lateral cartilages,the lower lateral cartilages were released and could be pulled down freely.After septal cartilage harvesting,a 4-5mm ×10^-15mm piece of septal cartilage graft was presented.Its distal end was inserted into and sutured with the tip of the silicone implant.Another end of the graft was sutured to the leaving bridge of septal cartilage.The released lower lateral cartilages were then caudally rotated and their domal segments were sutured at the middle line wrapping over the caudally projected tip of the silicone implant.The undermined dorsal skin was also pulled down by an intra-dermal suture at the position of supratip break.Then the supratip break could be anchored to the implant tip wrapped by the LLC. Results 17 patients asking nasal augmentation and lengthening have accepted the operation.The mean postoperative follow-up duration was 9.3months.The results were evaluated by nasolabial angel （NLA）changed by the operation,which had a notable decreasing of 10.7° ±3.5° . Conclusions In our technique,the silicone implant was supported effectively by a small piece of septal cartilage to confront the STSE-LLC retraction force generated in nasal lengthening procedure.