特殊形态假体复合自体软骨大三角支架:一种鼻综合整形的新技术

A triangle composite of special nasal prosthesis and autologous cartilage strut:A novel technique for comprehensive augmentation rhinoplasty

目的介绍一种以特殊形态假体抬高鼻背,利用自体软骨构建大三角支架塑形鼻尖的鼻综合整形术式,并评估其临床效果。方法鼻背处使用特殊形态的硅胶或膨体假体,尾侧正中矢状面剖开,将修剪好的片状鼻中隔软骨(或肋软骨)作为支撑材料置入假体尾侧中缝,下端与鼻中隔软骨尾侧端重合5 mm以上。在重合区域的两侧用两片耳软骨片作为辅助支撑材料加固,其下端与前鼻棘衔接。我们回顾性分析了47例接受了此法的鼻综合整形患者,评估其术后效果和并发症。结果本组47例患者术后即刻均能获得满意外形效果,鼻根鼻背高度增加,鼻背曲线,鼻额角、鼻尖突出度和角度、鼻唇角均有明显改善。术后切口均一期愈合,无并发症发生。其中29例(61.7%)完成随访,随访时间6-24个月,鼻部形态保持良好,支架结构稳定,未发现鼻尖下降、鼻头偏斜、鼻长缩短等症状。结论特殊形态假体复合自体软骨大三角支架的鼻综合整形术式,稳定性高,术后效果好,尤其是用于鼻整形修复手术更有优势,值得推广。

Objective To describe a novel technique for comprehensive augmentation rhinoplasty using a triangle composite of nasal prothesis and autologous grafts and to evaluate its clinical outcomes.Methods Silicone or ePTFE nasal prothesis was used to augment the nasal dorsum.The caudal end of the prothesis was incised along its midline.A slice of cartilage graft derived from nasal septum or costicartilage was inserted into the midline incision and fixed with sutures.The other end of this cartilage graft was 5-mm overlapped with the caudal nasal septum and was splinted with 2 slices of auricular cartilage.The auricular cartilage grafts were connected with and supported by the anterior nasal spine.We retrospectively analyzed 47 patients and evaluated the outcomes and complications.Results All patients reported satisfaction regarding their postoperative nasal contour.Augmentation of nasion and nasal dorsum,improvement of dorsal curve,nasofrontal angle,nasal tip projection and anlge,nasolabial angle were observed.All incisions achieved primary healing without complications.In 29 of 47(61.7%)patients,well-maitained nasal contours with stable cartilage frameworks were found without nasal length shortening,nasal tip reduction and deviation during a follow-up from 6 months to 2 years.Conclusion Triangle composite of special nasal prosthesis and autologous cartilage grafts is a novel and stable method for comprehensive augmentation rhinoplasty with favorable clinical outomes,especially for secondary rhinoplasty。