Byrd H S, Salomon J
Department of Plastic Surgery at the University of Texas Southwestern Medical Center, Dallas, USA.
Plast Reconstr Surg. 2000 Nov;106(6):1276-86. doi: 10.1097/00006534-200011000-00007.
An 18-year experience with the management of the unilateral cleft nasal deformity in 1200 patients is presented. A primary cleft nasal correction was performed at the time of lip repair in infancy; a secondary rhinoplasty was done in adolescence after nasal growth was complete. The technical details of the authors' primary cleft nasal correction are described. Exposure was obtained through the incisions of the rotation-advancement design. The cartilaginous framework was widely undermined from the skin envelope. The nasal lining was released from the piriform aperture, and a new maxillary platform was created on the cleft side by rotating a "muscular roll" underneath the cleft nasal ala. The alar web was then managed by using a mattress suture running from the web cartilage to the facial musculature. In 60 percent of cases, these maneuvers were sufficient to produce symmetrical dome projection and nostril symmetry. In the other 40 percent, characterized by more severe hypoplasia of the cleft lower lateral cartilage, an inverted U infracartilaginous incision and an alar dome supporting suture (Tajima) to the contralateral upper cartilage were used. Residual dorsal hooding of the lower lateral cartilage was most effectively managed with this suture. This primary approach to the cleft nasal deformity permits more balanced growth and development of the ala and domal complex. Some of the psychological trauma of the early school years may be avoided. Also, because of the early repositioning of the cleft nasal cartilages, the deformity addressed at the time of the adult rhinoplasty is less severe and more amenable to an optimal final result.
本文介绍了对1200例单侧唇裂鼻畸形患者进行治疗的18年经验。婴儿期唇修复时同期进行一期唇裂鼻矫正；青春期鼻生长发育完成后进行二期鼻整形术。文中描述了作者一期唇裂鼻矫正的技术细节。通过旋转推进设计的切口获得暴露。软骨支架从皮肤包膜广泛分离。鼻黏膜从梨状孔松解，通过在唇裂鼻小柱下方旋转“肌束”在裂隙侧创建新的上颌平台。然后通过从鼻翼软骨至面部肌肉组织的褥式缝合处理鼻翼蹼。60%的病例中，这些操作足以产生对称的鼻翼穹隆突出和鼻孔对称。另外40%的病例，其特征为裂隙侧下外侧软骨发育不全更严重，采用倒U形软骨下切口及对侧上侧软骨的鼻翼穹隆支撑缝合（田岛缝合法）。这种缝合最有效地处理了下外侧软骨残留的背侧覆盖。这种唇裂鼻畸形的一期治疗方法可使鼻翼和穹隆复合体获得更平衡的生长发育。可避免早期学龄期的一些心理创伤。此外，由于唇裂鼻软骨的早期复位，成年鼻整形术时处理的畸形较轻，更易于获得最佳的最终效果。
