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目的应用自体鼻中隔软骨-硅胶复合体二期修复先天性单侧唇裂鼻畸形,评价其疗效。方法2001年6月-2007年6月,收治单侧唇裂修复术后鼻畸形伴鼻中隔偏斜患者38例。男21例,女17例;年龄14～23岁,平均17.6岁。其中左侧26例,右侧12例;完全性21例,不完全性17例。畸形主要为鼻小柱偏向健侧、鼻尖低平圆钝、鼻孔不对称及患侧鼻翼塌陷。均为二期修复。患者曾行手术1～4次,上次手术至此次手术时间3～10年,平均5.5年。术中根据鼻畸形取自体鼻中隔软骨1.8cm×1.2cm,植入鼻尖部假体表面以延长鼻小柱,抬高鼻尖,将多余的软骨植于塌陷鼻翼处,同时行鼻尖部脂肪结缔组织瓣移位,固定后将患侧鼻翼软骨和软组织复位至正常解剖位置。结果患者术后切口均Ⅰ期愈合,供软骨区无并发症发生。鼻外形美观,鼻尖高度及形态自然、双鼻孔大小基本对称,鼻小柱居中,鼻尖扁平及鼻翼塌陷均不同程度矫正,鼻唇角生理弧度恢复。38例均获随访,随访时间12～18个月,平均15.6个月。随访12个月时患者满意30例(78.9%),较满意8例(21.1%)。患者均无移植软骨移位及外露,无出血、感染等并发症,外形良好。结论应用自体鼻中隔软骨-硅胶复合体移植是修复单侧唇裂鼻畸形一种较理想的术式。
Objective To repair nasal deformities of congenital unilateral cleft lip with autologous septal cartilage-silica gel complex and evaluate its curative effect. Methods From June 2001 to June 2007, 38 patients with nasal deformity and nasal septum deviation after unilateral cleft lip repair were treated. 21 males and 17 females; aged 14 to 23 years, mean 17.6 years old. There were 26 cases on the left side and 12 cases on the right side; 21 cases were complete and 17 cases were incomplete. Deformity is mainly skeletal deviation toward the side of the columella, nasal tip low blunt, nasal asymmetry and ipsilateral collapse of the nose. Are two repair. Patients had surgery 1 to 4 times, the last operation to the time of surgery 3 to 10 years, an average of 5.5 years. Intraoperative nasal denervation from autologous septal cartilage 1.8cm × 1.2cm, implanted nasal tip prosthesis surface to extend the columella, raise the tip of the nose, the excess cartilage planted in the collapse of the nose at the same time, the tip of the tip of the fat connective tissue flap Displacement, fixation of the affected side of the alar cartilage and soft tissue to normal anatomic position. Results The incisions were all healed by first intention and no complications occurred in the cartilage area. Nasal appearance, nose height and shape of the natural, double nostril size of the basic symmetry, nasal columella, nasal tip flat and nose collapse were corrected to varying degrees, nasolabial physiological radii restored. All 38 patients were followed up for 12-18 months with an average of 15.6 months. At the 12-month follow-up, 30 patients (78.9%) were satisfied and 8 patients (21.1%) were more satisfied. No patients with transplant cartilage displacement and exposure, no bleeding, infection and other complications, good shape. Conclusion Autologous septal cartilage - silicone composite graft is an ideal surgical procedure for repairing unilateral cleft lip nasal deformity.