Anderl Hans, Hussl Heribert, Ninkovic Milomir
Innsbruck, Austria; and Munich, Germany From the Department of Plastic and Reconstructive Surgery, University Hospital, and the Department of Plastic Surgery, Klinikum Bogenhausen.
Plast Reconstr Surg. 2008 Mar;121(3):959-970. doi: 10.1097/01.prs.0000299942.84302.16.
"Do not touch the nose in primary repair of the unilateral cleft lip and palate!" In the past, this dogmatic attitude caused functional and aesthetic (psychological) problems for the child until secondary corrections during adolescence were performed. In the 1950s, surgeons started to correct at least a few features of the nasal deformity and to develop radically corrective measures. Since 1970, a new and very comprehensive concept of correction has been used at the authors' department of plastic and reconstructive surgery.
Methods of primary nasal repair by various surgeons are presented chronologically. The main features of the authors' strategy are special incision lines, extensive mobilization of all dislocated structures, straightening of the deviated septum, correction of the deformed ala and nasal tip, induction of bone growth in hypoplastic areas under the alar base and along the piriform aperture, and a special suture technique of the orbicularis muscle to form a better philtrum.
Improvement of the aesthetic and functional results can be achieved with this type of nasal repair. Since 1970, approximately 500 patients have been operated on with this method at the authors' hospital and elsewhere, with 80 percent showing satisfactory results and 20 percent revealing deficiencies. Severe nasal deformities, which were common when no primary repair was applied, were not observed. This observation period provides evidence that no growth retardation occurs.
Because of the good results of this method and the lack of growth retardation, this approach is to be recommended. It also benefits children in underdeveloped countries, where frequent surgery is not possible.
“单侧唇腭裂一期修复时不要触碰鼻子！”过去，这种教条式的态度给患儿带来了功能和美观（心理）问题，直到青春期进行二期矫正。20世纪50年代，外科医生开始至少矫正一些鼻畸形特征，并制定彻底的矫正措施。自1970年以来，作者所在的整形与重建外科科室采用了一种全新且非常全面的矫正理念。
按时间顺序介绍了不同外科医生进行一期鼻修复的方法。作者策略的主要特点是特殊的切口线、广泛 mobilization 所有移位结构、矫正偏曲的鼻中隔、矫正变形的鼻翼和鼻尖、在鼻翼基部下方和沿梨状孔的发育不全区域诱导骨生长，以及一种特殊的口轮匝肌缝合技术以形成更好的人中。
通过这种类型的鼻修复可实现美观和功能结果的改善。自1970年以来，作者所在医院及其他地方约有500例患者采用此方法进行了手术，80%显示出满意的结果，20%存在缺陷。未观察到在不进行一期修复时常见的严重鼻畸形。这个观察期提供了证据表明不会发生生长迟缓。
由于这种方法效果良好且不存在生长迟缓，因此推荐采用这种方法。它也使欠发达国家的儿童受益，在这些国家频繁手术是不可能的。
