腹直肌筋膜-肋软骨颗粒复合体在单侧唇裂二期鼻整形中的应用

Application of diced costal cartilage wrapped in rectus abdominis fascia for nasal dorsum augmentation in secondary unilateral cleft lip nasal deformity

目的:探讨腹直肌筋膜包裹肋软骨颗粒作为鼻背移植物应用于单侧唇裂继发鼻畸形整复中的治疗效果。方法:回顾性分析35例单侧唇裂继发鼻畸形患者,采用腹直肌筋膜包裹肋软骨颗粒作为鼻背移植物矫正鼻背畸形。通过拍摄术前、术后二维照片测量鼻侧貌美学角度。统计术后患者满意度。结果:患者术后鼻面角、鼻尖旋转度较术前明显增大,鼻颏角减小,鼻孔轴线角比值增大,差异有统计学意义(P<0.05)。患者鼻畸形矫正程度显著,患者对手术效果满意。结论:腹直肌筋膜包裹肋软骨颗粒在单侧唇裂继发鼻畸形整复中可有效抬高鼻背,改善鼻侧貌美学曲线,在临床上具有推广意义。

Objective:To evaluate the effectiveness of diced costal cartilage wrapped in rectus abdominis fascia as nasal dorsum graft in the correction of secondary unilateral cleft lip nasal deformity.Methods:A retrospective study was performed on 35 patients with secondary unilateral cleft lip nasal deformity between January 2020 and April 2022.The patients admitted to the Hospital of Stomatology of Wuhan University,including 21 males and 14 females;aged 16-32 years.The autologous costal cartilage-based open rhinoplasty was used for the treatment,and nasal dorsum augmentation using the diced costal cartilage wrapped in rectus abdominis fascia technique.Preoperative and postoperative photos were taken in the anteroposterior position and lateral positions,and the facial profile aesthetic angle indicators were measured.Patients’subjective satisfaction,complications including graft resorption,warping,and visibility were recorded and evaluated.Results:The incisions healed by the first intention after the operation,and no complications such as cartilage exposure or acute infection occurred.All 35 patients were followed up for 6 to 16 months.During the follow-up,the patient’s nasal shape remained good,the nasal dorsum was raised,and improvement of dorsal aesthetic lines was achieved.The nasal tip and columella were basically centered,the tip definition was improved,and the collapse of the affected side of the nasal alar was lessened significantly than preoperatively.None of the patients had cartilage warping,visibility,and absorption.The indexes of nasofacial angle,nasomental angle,tip rotation,and the ratio of bilateral nostril axis angle were significantly improved after the operation when compared with preoperatively(P<0.05).All of the patients’nasal deformities were greatly improved,and they were satisfied with the effectiveness.Conclusion:Diced costal cartilage wrapped in rectus abdominis fascia can be used for nasal dorsum augmentation in secondary unilateral cleft lip nasal deformity.The postoperative efficacy was stable and patients’satisfaction rate was high.This technique has promotion significance in clinics.