鼻中隔軟骨在短鼻畸形鼻整形術(shù)中的應(yīng)用分析
發(fā)布時間：2018-11-26 21:07
【摘要】：目的當前鼻整形術(shù)已從早期簡單的單純隆鼻發(fā)展到綜合隆鼻階段。單純隆鼻術(shù)僅是用鼻假體增高鼻根、鼻背,對鼻尖部形態(tài)改善欠佳,隨著人們要求的提高,滿意率越要越不高。而且隨著時間推移,假體長期對鼻尖部皮膚頂壓,使得鼻尖部皮膚發(fā)紅變薄,假體穿破皮膚、外露有較高的發(fā)生率。綜合鼻整形術(shù)是運用綜合方法同時解決鼻根鼻背凹陷低平、鼻尖肥大低平、鼻背駝峰、鼻翼肥大、朝天鼻短鼻、鼻孔形態(tài)、骨性鼻基過寬等一系列鼻部美容問題。在這些鼻外觀不佳的情況中,鼻尖旋轉(zhuǎn)度過大致使鼻尖點向頭側(cè)上移,從而導(dǎo)致外觀鼻長度變短,鼻孔顯露過多,形成“朝天鼻”狀。這一鼻外觀不佳稱之為短鼻畸形,在鼻整形術(shù)中是較難處理。本課題就是運用自體的鼻中隔軟骨,行鼻中隔延伸移植,矯正鼻唇角過大,延長鼻長,改善鼻外觀。方法對納入課題研究的病例術(shù)前測量鼻長、理想鼻長、鼻尖突出度、額鼻角、鼻唇角、中面部長度、下面部長度等數(shù)值。對不同的患者采取個性化手術(shù)方案,手術(shù)采用開放切口,保留鼻中隔軟骨背側(cè)和尾側(cè)各1cm寬的軟骨后切取鼻中隔軟骨。切取下的鼻中隔軟骨適當裁剪,行鼻中隔一側(cè)尾側(cè)延伸,采取固定——懸浮式縫合固定法固定,對側(cè)采用撐開移植,兩塊軟骨片在鼻尖部相交縫合固定。術(shù)中對獲取的鼻中隔軟骨較小者再輔助用耳軟骨,假體雕刻成柳葉形,鼻尖部位沒有假體。手術(shù)綜合運用軟骨、皮膚軟組織的處理來延長鼻長,以達到滿意的手術(shù)效果。術(shù)后將研究病例術(shù)中僅用鼻中隔軟骨的分為A組,鼻中隔軟骨加耳軟骨的病例為B組。所有研究病例測量術(shù)后6個月的鼻長、理想鼻長、鼻尖突出度、額鼻角、鼻唇角等數(shù)值。上述術(shù)前術(shù)后測量數(shù)值用方差分析法統(tǒng)計分析,并將A、B兩組患者術(shù)后與術(shù)前測量差值也進行方差學(xué)分析。結(jié)果鼻長平均延長4.55mm、理想鼻長延長2.85mm、鼻尖突出度增2.66mm、鼻額角增大8.26度、鼻唇角減小7.57度。A、B兩組患者的術(shù)前術(shù)后鼻長、理想鼻長、鼻尖突出度、鼻額角、鼻唇角等測量指標比較,P值均小于0.05,具有統(tǒng)計學(xué)意義。A、B兩組之間的術(shù)前術(shù)后差異值比較,其P值均大于0.05,不具有統(tǒng)計學(xué)意義。所有36例病例手術(shù)后均一期愈合,1例術(shù)后鼻假體左偏,術(shù)后3周行修復(fù)手術(shù),1例由于所取鼻中隔軟骨過小,術(shù)后效果雖有改善但不理想,但患者拒絕自體肋軟骨移植,未再處理。結(jié)論鼻中隔軟骨延伸移植是矯正短鼻畸形的行之有效的手術(shù)方法,手術(shù)不復(fù)雜,安全有效,能有效改善鼻尖部形態(tài),使鼻外觀達到或接近人體鼻部美學(xué)標準。對預(yù)估自體鼻中隔軟骨過小者,為保障手術(shù)效果,建議用自體肋軟骨。鼻尖部全部使用軟骨,避免使用假體,增加術(shù)后遠期安全系數(shù),能有效避免鼻尖部皮膚變薄、假體突頂、皮膚穿破假體外露的術(shù)后并發(fā)癥。
[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.
【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R765.9
本文編號：2359622
[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.
【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R765.9
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