Kalogjera Livije, Bedeković Vlado, Baudoin Tomislav, Ivkić Mirko
Department of Otorhinolaryngology/Head and Neck Surgery, University Hospital Sestre milosrdnice, Zagreb, Croatia.
Aesthetic Plast Surg. 2003 May-Jun;27(3):209-12. doi: 10.1007/s00266-003-0005-1. Epub 2003 Oct 13.
Reconstruction of the saddle nose may involve the use of different augmentation materials, from autogenous bone and cartilage to alloplastic materials. The most important problems when considering the choice of reconstructive technique, besides underlying pathology and expected result, include: long-term stability, donor morbidity, tendency of the implant to infection, extrusion, and resorption. The use of the lateral crura of the lower lateral cartilages as dorsal onlay was reserved for the corrections of minor supratip depressions (flying wing and alar swing procedure). The authors suggest the use of pedicled flaps of cephalic portions of lateral crura as dorsal septal strut, which may increase the profile line more than dorsal onlay. Reconstruction is performed using open rhinoplasty approach. Pedicled flaps of the cephalic portions of lateral crura are transfixed in the sagittal plane and, following separation of upper lateral cartilages and medial crura, placed on the dorsum of nasal septum. Upper laterals are sutured to newly formed cartilaginous dorsum, or a new bridge is created using conchal cartilage. Columellar strut may be formed of the septal cartilage. Authors have performed such corrections in 15 patients with good long-term functional and aesthetic results.
鞍鼻重建可能涉及使用不同的填充材料，从自体骨和软骨到异体材料。在考虑选择重建技术时，除了潜在的病理情况和预期结果外，最重要的问题包括：长期稳定性、供体发病率、植入物感染、挤出和吸收的倾向。使用下外侧软骨的外侧脚作为背侧覆盖物仅用于矫正轻微的鼻尖上凹陷（飞翼和鼻翼摆动手术）。作者建议使用外侧脚头部的带蒂皮瓣作为鼻中隔背侧支柱，这可能比背侧覆盖物更能增加轮廓线。使用开放式鼻整形术进行重建。外侧脚头部的带蒂皮瓣在矢状面固定，在上外侧软骨和内侧脚分离后，放置在鼻中隔背侧。上外侧软骨缝合到新形成的软骨背侧，或使用耳甲软骨创建一个新桥。鼻中隔支柱可由鼻中隔软骨形成。作者已对15例患者进行了此类矫正，取得了良好的长期功能和美学效果。
