摘要
目的探讨运用内镜辅助切取鼻中隔软骨和筛骨垂直板完成鼻尖整形的相关经验和临床效果。方法2018年2月至2019年12月,中国医学科学院北京协和医学院整形外科医院整形三科采用鼻中隔延伸物移植术治疗20例女性短鼻患者,年龄20~38岁,平均28岁。术中以内镜辅助切取鼻中隔软骨和筛骨垂直板,获取鼻中隔软骨平均面积为22 mm×15 mm,筛骨垂直板骨片平均面积为26 mm×16 mm,鼻中隔保留10 mm宽度的L形支架。切取的鼻中隔软骨和筛骨垂直板分别作为鼻小柱支撑物和撑开鼻中隔延伸移植物重塑鼻尖形态,鼻背置入膨体聚四氟乙烯以增加高度。手术前、后分别测量患者鼻根点与鼻尖点的距离,通过配对t检验分析差值变化评估手术效果。结果本组20例术后均获3~12个月随访,平均9个月。20例患者鼻背平直、鼻拱对称、鼻小柱无歪斜,鼻尖柔软无僵硬感。手术前后鼻根点与鼻尖点距离的差异有统计学意义(P<0.05)。2例患者诉嗅觉减退,观察4个月后自行恢复;1例术后自觉鼻尖高度改善不满意。术后患者均未出现假体外露、鼻中隔穿孔等不良并发症,未出现鼻通气不畅及其他功能障碍。结论内镜可以辅助术者在直视下完成对鼻中隔软骨和筛骨垂直板安全且准确的切取。鼻中隔软骨联合筛骨垂直板制备的鼻中隔延伸物可以有效延长鼻的长度。
Objective To explore the experience and clinical effect of endoscopic assisted resection of septal cartilage and ethmoid bone vertical plate in rhinoplasty.Methods Twenty women with short noses underwent septal extension graft from February 2018 to September 2019.Endoscopic technique was utilized to harvest the septal cartilage and ethmoid vertical plate.During the operation,the average area of septal cartilage was 22 mm×15 mm,the average area of ethmoid bone vertical plate was 26mm×16mm,and the septum retained a 10 mm wide"L"sturt.The septal cartilage and the vertical plate of the ethmoid bone were used as the columella strut and the extension graft respectively to reconstruct the shape of the tip of the nose.Expanded polytetrafluoroethylene was implanted in the nasal dorsum to increase its height.Results The patients were followed up for 3-12 months at an average of 9 months.20 patients achieved straight back of nose,symmetrical arch of nose and no deviation of columella.The tip of nose is soft without rigidity.There was no exposure of prosthesis or perforation of nasal septum.There was significant differences in the distance between the root and tip of nose before and after operation(P<0.05).2 patients complained of olfactory hypoesthesia and recovered spontaneously after 4 months.1 patient was not satisfied with the improvement of the nasal projection.There was no obstruction of nasal ventilation and other dysfunction after operation.Conclusions Endoscopy can assist the operator to harvest the septal cartilage and ethmoid bone vertical plate safely and accurately.The extension of nasal septum prepared by the cartilage of nasal septum combined with the vertical plate of ethmoid bone can effectively increase the length of nose.
作者
周栩
吴乐昊
李孔盈
李秉航
王佳琦
Zhou Xu;Wu Lehao;Li Kongying;Li Binghang;Wang Jiaqi(Head and Neck Cosmetic Surgery Center,Plastic Surgery Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100144,China)
出处
《中华整形外科杂志》
CAS
CSCD
北大核心
2020年第7期764-769,共6页
Chinese Journal of Plastic Surgery
基金
首都特色——辅助人耳廓支架设计与雕刻的数字化新技术(Z161100000516099)
国家自然科学基金委青年科学基金(81501687)。
关键词
鼻中隔软骨
筛骨垂直板
隆鼻术
膨体
Septal cartilage
Ethmoid bone
Rhinoplasty
Polytetrafluoroethylene
