鼻下端圆隆肥大的鼻成形术

The rhinoplasty of the lower nasal hypertrophy and roundness

目的 通过对鼻下端软组织各层血管密度的研究 ,探讨治疗鼻下端圆隆肥大的手术方法。方法 取新鲜尸体头颅 ,经甲醛墨汁液灌注 ,于鼻端、鼻背、面部、颈部取材 ,制成石蜡切片 ,伊红染色 ;图象分析法测量各层微血管密度。根据 18例患者鼻下端圆隆肥大表现 ,分别采用A类方法 :膨体聚四氟乙烯假体置入隆鼻术 +鼻翼切薄术 +缝合法鼻翼沟成形术 ;B类方法 :鼻翼浅筋膜切除术 +肋软骨移植隆鼻术 +鼻翼基底切除术 +缝合法鼻翼沟成形术 ;C类方法 :鼻尖鼻翼浅筋膜切除术 +纤维肌层切除术 ,Ⅱ期行鼻翼基底切除术 +缝合法鼻翼沟成形术。结果 鼻下端软组织各层微血管密度从大到小的顺序为软骨膜层、网状层、纤维肌层、乳头下层、浅筋膜层、乳头层。本组 18例鼻下端圆隆肥大患者术后效果优良 ,无严重并发症 ,但肿胀时间略延长。结论 ①鼻端皮瓣减薄术不致引起鼻端部皮肤血运严重障碍。②A ,B 。

Objective Through measuring the density of microangium in each layer of the lower nasal soft tissue, we studied proper methods on orthosis to the lower nasal hypertrophy and roundness. Methods The slices of the nasal soft tissue, which were immersed in black ink solution, were embedded with paraffin wax and stained with eosin. We measured the density of microangium in every layer by optic microscope. In accordance with the different manifestation of the 18 cases of lower nasal hypertrophy and roundness, we applied different operative methods as follows: method A, to reconstruct nose with polytetrafluoroethylene grafts and thining nasal wing and to form the ala gulf by suture, method B, resecting the superficial fascia of nasal wing and reconstruct nose with costal cartilage grafts, resecting the nasal wing bases and form the ala gulf by suture, and method C, resecting the nasal wing bases and form the ala gulf by suture after resecting superficial fascia of the nasal tip ala and fabric myomectomy. Results The density of the microangium in the layers of the lower nasal soft tissue from large to small were: perichondrium layer, reticular layer, fabric muscle layer, lower papillary layer, superficial fascia layer and papillary layer. 18 patients show favorable result and no severe complication occured thereafter, yet the average swelling time was longer than conventional nose reconstruction. Conclusion ①The nasal skin slice resection does not result in obstruction of blood circulation. ②Method A, B and C are ones of methods on orthosis to the lower nasal hypertrophy and roundness.