鼻中隔软骨在短鼻畸形鼻整形术中的应用分析

发布时间：2018-11-26 21:07

【摘要】：目的当前鼻整形术已从早期简单的单纯隆鼻发展到综合隆鼻阶段。单纯隆鼻术仅是用鼻假体增高鼻根、鼻背,对鼻尖部形态改善欠佳,随着人们要求的提高,满意率越要越不高。而且随着时间推移,假体长期对鼻尖部皮肤顶压,使得鼻尖部皮肤发红变薄,假体穿破皮肤、外露有较高的发生率。综合鼻整形术是运用综合方法同时解决鼻根鼻背凹陷低平、鼻尖肥大低平、鼻背驼峰、鼻翼肥大、朝天鼻短鼻、鼻孔形态、骨性鼻基过宽等一系列鼻部美容问题。在这些鼻外观不佳的情况中,鼻尖旋转度过大致使鼻尖点向头侧上移,从而导致外观鼻长度变短,鼻孔显露过多,形成“朝天鼻”状。这一鼻外观不佳称之为短鼻畸形,在鼻整形术中是较难处理。本课题就是运用自体的鼻中隔软骨,行鼻中隔延伸移植,矫正鼻唇角过大,延长鼻长,改善鼻外观。方法对纳入课题研究的病例术前测量鼻长、理想鼻长、鼻尖突出度、额鼻角、鼻唇角、中面部长度、下面部长度等数值。对不同的患者采取个性化手术方案,手术采用开放切口,保留鼻中隔软骨背侧和尾侧各1cm宽的软骨后切取鼻中隔软骨。切取下的鼻中隔软骨适当裁剪,行鼻中隔一侧尾侧延伸,采取固定——悬浮式缝合固定法固定,对侧采用撑开移植,两块软骨片在鼻尖部相交缝合固定。术中对获取的鼻中隔软骨较小者再辅助用耳软骨,假体雕刻成柳叶形,鼻尖部位没有假体。手术综合运用软骨、皮肤软组织的处理来延长鼻长,以达到满意的手术效果。术后将研究病例术中仅用鼻中隔软骨的分为A组,鼻中隔软骨加耳软骨的病例为B组。所有研究病例测量术后6个月的鼻长、理想鼻长、鼻尖突出度、额鼻角、鼻唇角等数值。上述术前术后测量数值用方差分析法统计分析,并将A、B两组患者术后与术前测量差值也进行方差学分析。结果鼻长平均延长4.55mm、理想鼻长延长2.85mm、鼻尖突出度增2.66mm、鼻额角增大8.26度、鼻唇角减小7.57度。A、B两组患者的术前术后鼻长、理想鼻长、鼻尖突出度、鼻额角、鼻唇角等测量指标比较,P值均小于0.05,具有统计学意义。A、B两组之间的术前术后差异值比较,其P值均大于0.05,不具有统计学意义。所有36例病例手术后均一期愈合,1例术后鼻假体左偏,术后3周行修复手术,1例由于所取鼻中隔软骨过小,术后效果虽有改善但不理想,但患者拒绝自体肋软骨移植,未再处理。结论鼻中隔软骨延伸移植是矫正短鼻畸形的行之有效的手术方法,手术不复杂,安全有效,能有效改善鼻尖部形态,使鼻外观达到或接近人体鼻部美学标准。对预估自体鼻中隔软骨过小者,为保障手术效果,建议用自体肋软骨。鼻尖部全部使用软骨,避免使用假体,增加术后远期安全系数,能有效避免鼻尖部皮肤变薄、假体突顶、皮肤穿破假体外露的术后并发症。
[Abstract]:Objective at present, rhinoplasty has developed from simple rhinoplasty in early stage to comprehensive rhinoplasty. The simple augmentation rhinoplasty is only to increase the nasal root and nasal dorsum with nasal prosthesis and improve the shape of nasal tip. With the increase of people's request, the satisfaction rate is less and less. And over time, the prosthesis pressure on the nasal tip skin for a long time, making the nasal tip skin redness and thinning, the prosthesis pierced the skin, and the incidence of exposure was higher. Comprehensive rhinoplasty is a comprehensive method to solve a series of nasal beauty problems, such as nasal root nasal depression low level, nasal tip hypertrophy, nasal hump, nasal wing hypertrophy, short nose, nose shape, bony nasal base too wide and so on. In these cases, when the nose tip rotates too much, the tip of the nose moves upward to the head, which results in the appearance of the nose becoming shorter and the nostrils exposed too much, forming a "nose toward the sky" shape. This nasal appearance is called short nose malformation, which is difficult to deal with during nasal plastic surgery. This topic is to use autologous nasal septum cartilage, nasal septum extension transplantation, correction of the nasal lip angle too large, extend the length of the nose, improve the nasal appearance. Methods the nasal length, ideal nasal length, nasal tip protrusion, frontal nose angle, nasal lip angle, middle facial length and lower length were measured before operation. Different patients were treated with individualized surgical procedures. Open incision was used to preserve the 1cm width of nasal septal cartilage in the dorsal and caudal sides of the nasal septum to remove the nasal septal cartilage. The nasal septum cartilage was cut properly, the nasal septal cartilage extended caudal side of nasal septum, fixed by fixed-suspension suture fixation method, the other side was fixed by distraction and transplantation, and two pieces of cartilage pieces intersected and sutured at the tip of the nose. Ear cartilage was used for the patients with smaller nasal septal cartilage. The prosthesis was carved into willow leaf shape and there was no prosthesis at the tip of nose. The treatment of cartilage and soft tissue is used to prolong the length of nose. After operation, the patients were divided into group A and group B with nasal septum cartilage and auricular cartilage. Nasal length, ideal nasal length, nasal apex protrusion, frontal nasal angle, nasolabial angle, and so on were measured in all cases 6 months after operation. The preoperative and postoperative measurements were statistically analyzed by the method of variance analysis, and the difference between the postoperative and preoperative measurements in two groups of patients with Agna B was also analyzed by ANOVA. Results the average nasal length was 4.55 mm, the ideal nasal length was 2.85 mm, the nasal tip protrusion was increased 2.66 mm, the nasal frontal angle was increased by 8.26 degrees, and the nasal lip angle was decreased by 7.57 degrees. The comparison of nasal apex protrusion, nasal frontal angle and nasolabial angle was significant (P < 0.05), and the difference between two groups was not statistically significant (P > 0.05). All 36 cases were healed at the first stage, 1 case had left deviation of nasal prosthesis, 3 weeks after operation, 1 case had improved but not ideal because of the small nasal septum cartilage, but the patient refused autogenous costal cartilage transplantation. No further treatment. Conclusion Transplantation of nasal septal cartilage is an effective surgical method for correction of short nasal deformity. The operation is not complicated, safe and effective. It can effectively improve the shape of nasal tip and make the nasal appearance up to or close to the human nasal aesthetic standard. In order to ensure the operation effect, autologous costal cartilage should be used to estimate the nasal septal cartilage in patients with small autologous nasal septal cartilage. Using cartilage in the tip of the nose, avoiding the use of prosthesis, increasing the long-term safety factor, can effectively avoid the complications of skin thinning of the tip of the nose, the top of the prosthetic process and the exposure of the skin through the prosthesis.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R765.9

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