单侧唇裂术后鼻畸形综合矫治临床分析

Clinical Study on Nasal Deformity After Unilateral Cleft Lip Surgery

目的:探讨一种有效的从骨-软骨-软组织-皮肤整体出发综合治疗单侧唇裂术后鼻畸形的手术方法及其临床应用效果。方法:2018年3月-2021年1月,对11例单侧唇裂术后鼻畸形患者采用软骨-皮肤整体推进的方法进行骨骼畸形的矫正与重建,并对皮肤软组织进行修复复位,评估手术效果及患者满意度。结果:该术式有效调整了鼻尖偏斜,恢复了鼻翼穹窿正确解剖位置,改变了鼻翼软骨内外侧脚之间的角度,改变了鼻翼向内侧扭曲,恢复了鼻翼-面沟角度,重建了鼻翼缺乏的软骨支撑,也使得鼻翼基底外侧移位得到恢复,恢复了患侧鼻孔周长,矫正了鼻背偏斜与移位,延长了患侧鼻小柱,矫正了患侧内侧脚向背侧移位与鼻小柱的倾斜。本组11例患者,术后随访6~34个月,唇裂鼻畸形在外形与功能上均取得了明显改善效果,且并发症少,远期效果肯定。结论:骨-软骨-软组织-皮肤整体出发综合治疗单侧唇裂术后鼻畸形,在兼顾外形改善的同时还具有较其他方式所不具备的改善鼻部功能的优势,近期、远期手术效果均很好。

Objective To explore an effective surgical method and clinical application in the comprehensive treatment of nasal deformity after unilateral cleft lip surgery from bone-cartilage-soft tissue-skin as a whole.Methods From March 2018 to January 2021,11 patients with nasal deformity after unilateral cleft lip surgery were corrected and reconstructed by cartilageskin propulsion method,and the skin soft tissue was repaired and reset,the surgical effect and patient satisfaction were evaluated.Results This operation effectively adjusted the tip deviation of the nose,restored the correct anatomical position of the alar dome,and changed the nose.The angle between the inner and outer feet of the alar cartilage changes the distortion of the alar to the inside,restores the alar-face groove angle,rebuilds the cartilage support that the alar lacks,restores the lateral displacement of the alar basement,restores the circumference of the affected side of the nostrils,corrects the dorsal deviation and displacement,prolongs the nasal column of the affected side,and corrects the inner part of the affected side.The side foot shifts to the dorsal side and the tilt of the nasal column.In 11 patients in this group,after follow-up for 6 to 34 months,cleft lip and nasal deformities have achieved significant improvement in shape and function,with few complications,and the long-term effect is positive.Conclusion The overall approach of bone,cartilage,soft tissue and skin for the comprehensive treatment of nasal deformities after unilateral cleft lip surgery not only takes into account the improvement of appearance,but also has the advantages of improving nasal function compared with other methods,and the short-term and long-term surgical effects are very good.