X形自体鼻中隔软骨扩展移植矫正短鼻的临床效果

Clinical efficacy of lengthening the short nose with X-septal extended spreader graft

目的 探讨自体鼻中隔软骨X形扩展移植和鼻背膨体聚四氟乙烯（e-PTFE）假体植入矫正短鼻的临床效果.方法 共收治29名女性短鼻美容就医者,年龄17-37岁,所有美容就医者都有鼻尖短小,鼻根鼻背部低平、鼻孔圆钝以及外露明显.采用自体鼻中隔软骨X形扩展移植和鼻背膨体聚四氟乙烯假体植入重建鼻尖部的支撑结构,使鼻尖获得足够的向前下方的支撑力,增加了鼻背长度并纠正鼻尖上旋,同时行盾牌状、帽状移植以进一步突出鼻尖的形态.对临床效果和并发症进行评价.结果 29名女性美容就医者术后鼻背均已延长,鼻尖上旋纠正,鼻唇角正常,鼻部形态满意.随访6-12个月,除有2例感觉鼻尖延长不足外,其余美容就医者鼻轮廓稳定,无感染、无假体偏斜、无移植软骨暴露、无延迟性炎症、无鼻中隔穿孔及鼻背凹陷等并发症发生.结论 短鼻要得到有效延长矫正,鼻尖需要获得强有力向前与向下方的支撑力,重建鼻下部的支撑结构是必需的.盾牌状、帽状软骨移植可进一步提高矫治效果.

Objective To investigate a safe and effective method of lengthening the short nose.Methods 29 females （17-37 years） with short nose were corrected with septal extended spreader grafts using autologous cartilage and combined with expanded polytetrafluoroethylene （e-PTFE） to reconstruct the supporting structures underneath to improve the upward and forward 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 technique.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 （infection,deviation,extrusion,and delayed inflammation,perforation of nasal septum and dorsal depression） were detected by follow-up from 6 to 12 months,except 2 patients felt tip extended defects.All the patients were pleased with the surgical results achieved.Conclusions It is necessary to provide powerful forward and upward strength to lengthen nose and correct the over rotation of nasal tip effectively and safely.The use of septal extended spreader grafts by autologous cartilage and combined with expanded polytetrafluoroethylene （e-PTFE） represents a valuable tool for the short nose and proper cartilage grafts can improve the height of the nasal tip and correct the over rotation of the nasal tip further.