鼻中隔偏曲的形态矫正

Correction of nasal septum deviation

目的探讨鼻中隔偏曲形态的矫正方法。方法2016年8月至2018年8月,上海玫瑰医疗美容医院对47例鼻中隔偏曲患者进行矫正,其中男11例,女36例,年龄18~43岁,平均23岁。术中保留L形支架后切取鼻中隔软骨,先通过对偏曲对侧的鼻中隔软骨进行划痕及软骨移植等措施,对鼻中隔背侧偏曲进行应力性和容积性矫正,再根据鼻中隔尾侧不同偏曲情况进行矫正。(1)Ⅰ类:前鼻嵴居中,鼻中隔后角连接在前鼻嵴上,鼻中隔尾侧向一侧弧形弯曲时,于弯曲软骨凹面作划痕,一侧放置软骨板条,形成单侧夹板矫正弯曲。(2)Ⅱ类:前鼻嵴居中,鼻中隔后角连接在前鼻嵴上,鼻中隔自后角向前角方向呈直线倾斜偏曲时,于尾侧偏曲方向的对侧将移植物自前鼻嵴向前放置,保证前角位置居中,作容积性矫正。(3)Ⅲ类:前鼻嵴居中,鼻中隔后角自前鼻嵴脱出并偏向一侧,鼻中隔尾侧直线偏曲或弧形弯曲时,将后角自错位点剥离并复位于前鼻嵴上,尾侧过长时予适当切除,根据尾侧的软骨强度及偏曲倾向行软骨加强移植。(4)Ⅳ类:前鼻嵴本身位置偏向一侧,鼻中隔后角连接于错位的前鼻嵴上时,保留约2 mm的软骨于前鼻嵴上方后,从前鼻嵴前方离断尾端并向中线复位,移位距离较大时在断端错位间隙内填充小软骨。如原前鼻嵴过于突出可予以凿除。根据尾侧端强度及偏曲倾向作软骨加强移植。观察患者术后效果。结果本组47例,Ⅰ类8例,Ⅱ类13例,Ⅲ类5例,Ⅳ类21例。平均随访1年3个月,1例Ⅱ类、2例Ⅳ类患者在术后1~3个月内出现偏曲的复发,于术后半年进行二次调整后基本达到满意;1例Ⅲ类患者术后一侧鼻腔通气不畅,检查为该侧下鼻甲肥大,后行下鼻甲肥大矫正术后缓解;余43例术后均恢复良好,鼻背与鼻尖及鼻小柱基本居中,鼻孔双侧基本对称,无其他并发症发生。结论将鼻中隔L形支架背侧和尾侧按不同偏曲情况进行针对性的矫正,可有效治疗因鼻中隔偏曲导致的鼻形态畸形。

Objective To study the correction of nasal septum deviation.Methods From August 2016 to August 2018,a total of 47 patients with nasal septum deviation were treated in Shanghai Mei-gui Medical Cosmetology Hospital,including 11 males and 36 females,aged from 18 to 43 years old,with an average age of 23 years old.After the L-shaped stent was retained during the operation,the nasal septum cartilage was cut off.Firstly,stress and volumetric correction of the dorsal deviation of nasal septum was done by nicked and grafted on the opposite side of the deviation of the nasal septum cartilage,then deviation of caudal of the nasal septum was corrected according to different cases.(1)CategoriesⅠ:The anterior nasal crest is centered.The posterior septum angle is attached to the anterior nasal crest.Caudal septum is arc curved to one side.The concave surface of the bent cartilage was scratched and a cartilage slat was placed on one side to form a unilateral splint and correct the bending.(2)CategoriesⅡ:The anterior nasal crest is centered.The posterior septum angle is attached to the anterior nasal crest and the nasal septum is tilted in a straight line in the forward direction.Volume correction was done by placing the graft forward from the anterior nasal crest on the opposite side of the caudal deflection to ensure that the anterior angle is centered.(3)CategoriesⅢ:The anterior nasal crest is centered.The posterior septum angle emerges from the anterior nasal crest and is tilted to one side.The nasal septum is curved or deviated in a straight line.The posterior angle was detached from the dislocation point and repositioned on the anterior nasal crest.The caudal length should be excised appropriately.Cartilage strengthening transplantation was performed according to the strength and deviating tendency of the caudal cartilage.(4)CategoriesⅣ:The anterior nasal crest is tilted to one side,and the posterior septum angle is connected to the misplaced anterior nasal crest,about 2 mm of cartilage remains above the anterior nasal crest.The anterior nasal crest is detached from the posterior end and repositioned toward the midline.When the displacement distance is large,small cartilage is filled in the gap between the broken ends.If the original anterior nasal crest is too prominent,it can be chiselled out.Then cartilage augmentation grafts were performed according to the strength and inclination of the caudal end.Postoperative effects were observed.Results A total of 47 cases were included.8 cases wereⅠclass,13 cases wereⅡclass,5 cases wereⅢclass and 21 cases wereⅣclass.The average follow-up period was 3 months to 1 year.Deviation recurrence occurred within 1-3 months after surgery in 1 case ofⅡclass and 2 case ofⅣclass.The second adjustment half a year after operation was satisfactory.One side of the nasal cavity was obstructed postoperatively in one case ofⅢclass.Examination revealed hypertrophy of the inferior turbinate on this side.Nasal congestion is relieved after correction of hypertrophy of inferior turbinate.The other 43 cases recovered well after operation.Dorsal of the nose and the tip and columellar are basically centered.Both nostrils are basically symmetrical,and no other complications occurred.Conclusions According to different circumstances of dorsal and caudal deviation of the nasal septum L-shaped stent and carry out targeted correction,nasal deformity caused by nasal septum deviation can be effectively treated.