单侧唇裂继发鼻畸形综合手术修复.docVIP

单侧唇裂继发鼻畸形综合手术修复[摘要]目的:探讨矫正单侧唇裂继发鼻畸形的方式和方法。方法:术前根据患者鼻部畸形程度进行分度,根据分度,采用开放式鼻整形切口,在充分解剖复位的基础上分别应用大翼软骨悬吊、软骨植入、膨体材料植入等方法,重塑患侧鼻翼、鼻孔形态。结果:从2005年3月～2010年3月间,单侧唇裂术后鼻畸形病例60例,行综合性治疗方案,矫正效果满意,术后切口愈合良好,随访6个月～1年,外鼻形态持久、满意,植入体无外露、感染等并发症。结论:采用综合手术治疗方法矫正单侧唇裂继发的鼻部畸形,效果满意,聚四氟乙烯作为异体材料,修复单侧唇裂继发鼻畸形可获得持久、满意的形态, 并发症少。 [关键词]唇裂继发畸形;鼻畸形;聚四氟乙烯 [中图分类号]R782.2[文献标识码]A[文章编号]1008-6455(2010)09-1284-04 Comprehensive treatment of secondary unilateral cleft lip nasal deformity CUI Ya-ning,WANG Xiao-jun,LIU Zhi-fei,ZHU lin,SI lou-bin,QIAO Qun Department of Plastic Surgery of Peking Union Medical College Hospital,The Chinese Academy of Medical Science,Beijing 100032,China) Abstract:ObjectiveTo explore a comprehensive treatment in repairing secondary unilateral cleft lip nasal deformity.MethodsAccording to the different levels of deformity,we took different treatments and correct all kinds of the factors that cause the nose deformity.ResultsThe repairing operation were performed in 60 cases from 2005 to 2010,the short nasal columella, flat tips and collapsed nasal ala were elevated. The view of noses was improved apparently. The outcome was satisfactory. Conclusion With the comprehensive plan and individual surgerical procedure,secondary unilateral cleft lip nasal deformity were corrected satisfactorily.PTFE is an optimal plastic material,which is compatible perfectly with circumferential tissues.The outcome of filling is excellent. Key words:unilateral cleft lip;secondary nasal deformity; polyterafluoroethylene 唇裂术后继发鼻唇畸形是整形科常见的疾病之一,给患者的生活带来了严重的影响,尽管唇裂手术方式不断改进,一期修复手术的术后效果亦大大改善,但由于一期手术修复时患者年龄小,各种解剖标识难以识别,往往不能保证完全的解剖复位,其次唇裂伴有的骨、软骨发育畸形随着年龄增长,不断显现,故大部分唇裂患者随年龄增长会显现唇鼻畸形,须在青春期后行二次手术修复。 二次修复手术决定着手术的最终效果,影响患者的心理及容貌美观,至关重要。和一次修复手术相比,二期修复术尚无标准方法。目前最常用的矫正唇裂继发鼻畸形方法有鼻翼软骨解剖复位、大翼软骨的悬吊及各种自体组织、异体组织植入修复,各种方法各有利弊。在充分了解唇裂术后鼻畸形解剖特征的基础上,根据患者的畸形特点,采用一种灵活的、能够很好修复唇裂术后各种鼻继发畸形的手术方式,是整形外科医师不断努力的目标。从2005年3月～2010年3月间我们根据唇裂术后鼻畸形的特点,分别采用鼻翼软骨复位、大翼软骨悬吊,自体软骨植入、聚四氟乙烯(膨体)植入等方法综合性矫正单侧唇裂继发鼻部畸形,获得了满意的效果。随诊6个月～1年,效果满意。