肋软骨皮质在鼻尖整形中的应用

Application of costal cartilage cortex for nasal tip contour improvement

目的探讨自体肋软骨皮质作为鼻尖支撑及修饰移植物在改善鼻尖形态中的应用效果。方法自2021年3月至2022年6月,河南整形美容医院美容外科对89例要求实施鼻尖成形术患者,采用CT辅助检查并切取肋软骨,将肋软骨皮质制作成“板条状”及“帽状”移植物,塑造鼻尖形态,膨体聚四氟乙烯或硅胶假体抬高鼻背行鼻整形术。采用照片测量法获取患者鼻面部参数,比较分析患者手术前后鼻面部参数,观察患者手术满意度及并发症发生情况。结果89例患者随访6~24个月,平均9个月。术后鼻腔内无占位、无移植物突出、患者自查外鼻阀无明显异物感觉、鼻尖可以左右摆动,同时鼻尖表现点明显,下鼻小叶饱满,无软骨显形、外露、感染等并发症发生。2例由于未处理鼻中隔偏曲,出现了鼻小柱偏斜,鼻孔左右不对称。测量结果显示,术后患者的鼻长度、鼻尖旋翘度、鼻额角、鼻尖突出度,均获明显改善,与术前比较,差异有统计学意义(P<0.05)。结论采用自体肋软骨皮质作为鼻尖支撑及修饰移植物改善鼻尖形态,塑造出的鼻尖柔软可活动,且不影响气道,是鼻尖整形中一项良好的手术技术,值得临床应用。

Objective To investigate the efficacy of autologous costal cartilage cortex as a nasal tip support and modification graft in improving the nasal tip morphology.Methods FromMarch 2021 to June 2022,89 patients who underwent rhinoplasty with a focus on nasal tip shaping were enrolled.CT scans were used as an auxiliary examination,and costal cartilage was harvested.The cortical layer of the costal cartilage was shaped into"plate-like"and"cap-like"grafts to sculpt the nasal tip morphology,while expanded polytetrafluoroethylene(ePTFE)or silicone implants were used to elevate the nasal dorsum.Photometric methods were employed to obtain the patients'nasofacial parameters,which were then compared before and after surgery to observe patient satisfaction and the occurrence of complications.Results All 89 patients were followed up for 6 to 24 months,with an average of 9 months.Postoperatively,there were no intranasal occupations or graft protrusions.Patients reported no foreign body sensation in the external nasal valve upon self-examination,and the nasal tip was able to move laterally.The nasal tip exhibited distinct tip-defining points,a full lower lateral cartilage lobule,and no complications such as cartilage visibility,exposure,or infection.Two patients experienced deviation of the nasal columella and asymmetrical nostrils due to unaddressed septal deviation.Measurement results showed significant improvements in postoperative nasal length,nasal tip rotation,nasofrontal angle,and nasal tip projection,with statistically significant differences compared to preoperative values(P<0.05).Conclusion The application of autologous costal cartilage cortex as a nasal tip support and modifying graft to improve nasal tip morphology is a good surgical technique.The shaped nasal tip is soft and movable without affecting the airway,making it worthy of clinical application.