筛骨垂直板在矫正中国人鼻中隔短小短鼻畸形中的应用

Application of perpendicular plate of ethmoid bone in short nose plasty in Chinese with insufficient septal cartilage

目的探讨鼻中隔软骨联合筛骨垂直板移植在矫正中国人鼻中隔短小短鼻畸形中的应用价值。方法从2015年2月至2017年3月，对35例不同程度的短鼻畸形患者采用筛骨垂直板移植物强化鼻中隔尾侧及背侧的L形支架结构，保留宽0．6cm中隔尾侧、背侧段的L形鼻中隔软骨，将所获取的中隔软骨固定于尾端延长鼻支撑结构，最后与双侧鼻翼软骨固定，耳软骨修饰鼻尖。测量术前与术后鼻长和鼻小柱上唇角度。结果在35例患者中，平均鼻长增加（3．37±1．87）mm（P〈0．05）。术后无感染、无脑脊液漏、无出血等并发症。平均随访时间为10个月（6个月至2年），33例对术后鼻部形态满意，I例自诉鼻尖突出过度，另有1例自诉鼻尖突出不足，均行二次局部手术调整。结论鼻中隔软骨联合筛骨垂直板移植物在中隔软骨量极少的短鼻病例中，能够充分延长鼻支撑结构，可有效增加鼻长，减少鼻孔外露。该技术手术并发症少，患者满意度高。

Objective To evaluate the applied value of septal cartilage combined with perpendic- ular plate of ethmoid bone graft in short nose plasty in Chinese people with insufficient septal cartilage. Methods From February 2015 to March 2017, thirty-five women with short noses underwent septal extension grafting in our institute. We used perpendicular plate of ethmoid bone to enhance the L-strut structure. An L-strut, comprising 0.6 cm segments of the caudal and dorsal cartilaginous septum, was left altered to harvest more cartilages for septal extension. The harvested septal cartilage was grafted on one side of the caudal septum. Then the alar cartilage was fixed at the end of the septal cartilage graft. Nasal lengths and nasolabial angles were measured pre- and postoperatively. Results The aver- age nasal lengthening was （3.37± 1.87） mm （P〈0.001）. There was no infection, cerebral spinal fluid leakage, hemorrhage and other complications postoperatively. The average follow-up was 10 months （6 months to 2 years）. After operation, 33 patients were satisfied with the nasal contour, 1 patient complained of high tip projection whereas one patient complained of low tip projection, and the dissat- isfactions were corrected by revision surgeries. Conclusions Combining the septal cartilage with per- pendicular plate of ethmoid bone graft presents an adequate nose lengthening and a decreased nostril show, even in patients with very little septal cartilage. With minimum complications, this novel tech- nique provides promising clinical outcomes and high patient satisfaction.