经皮肤入路鼻外侧截骨术在鼻整形中的应用

Application of transcutaneous lateral nasal osteotomy in rhinoplasty

目的 探讨经皮肤入路鼻外侧截骨术在鼻整形中的应用效果.方法 对12例鼻外形不佳者行皮肤入路鼻外侧截骨术,于双侧鼻面沟中部做一长约2 mm的皮肤切口,通过此切口插入一锋利的宽为2 mm的截骨刀直达骨膜下,沿双侧鼻面沟设计的截骨线每隔2mm间断截断上颌骨额突.完成截骨后,用指力向内侧挤压鼻骨,造成青枝骨折,重塑理想的骨性鼻锥.7例患者同时行假体隆鼻、鼻中隔延长等手术.结果 所有患者术后骨性鼻锥外形均得到明显改善.术后早期眶周淤血、水肿等症状较轻,随访2～9个月未发生通气功能异常,双侧鼻骨未发生明显的不对称,皮肤切口瘢痕不明显,未发生色素沉着等并发症.结论 采用经皮肤入路鼻外侧截骨术重塑骨性鼻锥,易于操作,方法精确、安全,效果确切,术后并发症较少,是一种值得推广的手术方法.

Objective To investigate the effect of transcutaneous lateral nasal osteotomy applied in rhinoplasty. Methods Twelve patients with poor nasal shape underwent transcutaneous lateral nasal osteotomy. Using a 2 mm sharp osteotome, a 2 mm incision was made at the middle of the nasofacial junction to the periosteum. An intermittent cut every 2 mm following the cutting line designed along the bilateral nasofaeial sulcus was made to the processus frontalis. Subsequently, greenstiek fractures of nasal bone were induced by gentle force with fingers to reform the ideal bony nose cone. Seven patients were also treated with other procedures such as implant augmentation and septal extension. Results All patients received obviously improved shape of nasal bony cone after surgery. Early postoperative periorbital edema and congestion were mild. No instances of abnormal ventilation, bilateral nasal bone asymmetry, or pigmentation were found during follow-up for 2 to 9 months, and the skin incision scars were concealed. Conclusion Transcutaneous lateral nasal osteotomy for reshaping nasal bony cone is simpleand convenient for the surgeon, resulting in accurate and safe osteotomy. The obvious effectiveness and few complications make this a procedure worthy of wider application.