Taji Megumi, Takato Tsuyoshi, Susami Takafumi, Eguchi Tomoaki
Plastic and Reconstructive Surgery, Yaizu City Hospital, Dohara, Yaizu-shi, Shizuoka, Japan.
J Craniofac Surg. 2005 Jul;16(4):672-5. doi: 10.1097/01.scs.0000168776.94227.67.
In reconstruction necessitated by severe hypoplasia or a columella defect, the surgeon must consider various factors in each case, such as the characteristic columellar shape, color match, texture, patient age, original disease, and surrounding scars. In these cases, reconstruction of both the cartilaginous strut and the overlying skin is necessary and important to obtain good results. The authors report three cases of reconstruction of the columella with satisfactory results. Case 1 involved a 6-year-old girl with complete bilateral cleft lip and severe hypoplasia of the premaxilla and prolabium. Columellar reconstruction was performed with small triangular flaps at the columella base, together with a rib chondral graft for cartilaginous support. Case 2 involved a 12-year-old girl with a complete bilateral cleft lip and cleft palate. Columellar reconstruction was performed with small triangular flaps at the columella base, together with bilateral conchal cartilage grafts. Case 3 involved a 17-year-old boy with a right complete cleft lip and columellar defect caused by previous infection after secondary cheiloplasty. Columellar reconstruction was performed using a left nasal vestibular flap and septal cartilage grafting, together with a bilateral conchal cartilage graft beneath the flap. The authors consider the unilateral nasal vestibular flap to be very useful in carefully selected unilateral cleft cases.
在因严重发育不全或鼻小柱缺损而需要进行重建时，外科医生必须针对每个病例考虑各种因素，例如鼻小柱的特征形状、颜色匹配、质地、患者年龄、原发病以及周围瘢痕。在这些情况下，重建软骨支柱和覆盖其上的皮肤对于获得良好效果是必要且重要的。作者报告了三例鼻小柱重建病例，效果令人满意。病例1为一名6岁女孩，双侧完全性唇裂，上颌前部和唇前严重发育不全。采用鼻小柱基部小三角形皮瓣进行鼻小柱重建，并使用肋软骨移植提供软骨支撑。病例2为一名12岁女孩，双侧完全性唇裂和腭裂。采用鼻小柱基部小三角形皮瓣进行鼻小柱重建，并使用双侧耳甲软骨移植。病例3为一名17岁男孩，右侧完全性唇裂，继发唇裂修复术后因先前感染导致鼻小柱缺损。采用左侧鼻前庭皮瓣和鼻中隔软骨移植进行鼻小柱重建，并在皮瓣下方使用双侧耳甲软骨移植。作者认为单侧鼻前庭皮瓣在精心挑选的单侧唇裂病例中非常有用。
