Robinson J K, Burget G C
Department of Dermatology, Northwestern University Medical School, Chicago, IL 60611.
Arch Otolaryngol Head Neck Surg. 1990 Dec;116(12):1419-24. doi: 10.1001/archotol.1990.01870120065011.
Following cancer resection of the nasal unit, nasal valve malfunction is manifested by the symptoms of nasal stuffiness or difficulty getting air into the nostril. These symptoms occur in cases in which the resection is in the alar crease at the junction with the lateral sidewall of the nose. Wound scar contracture elevates the alar margin and causes the alar and lateral cartilages to move inward forming a visible and palpable shelf on the lateral wall of the nasal vestibule. This displacement of the alar and lateral cartilages and the rigid scar formed between these cartilages render the nasal valve immobile. Since it is easier to prevent nasal valve malfunction than to repair it later, wounds that bridge the alar crease or are located in either the alae or lateral sidewall and come within 1 mm of the alar crease with a total diameter of 1.0 cm should be repaired to prevent nasal valve malfunction. In the process of repairing deep defects, the overlapping region of the lateral crus of the alar cartilage and the lateral cartilage may be stabilized by a conchal cartilage graft. This cartilage graft may be used in combination with reconstruction of the nasal skin with a forehead flap and repair of the nasal lining. In the event that the nasal lining is intact, the cartilage graft may be used with a full-thickness skin graft.
鼻单位癌症切除术后，鼻瓣功能障碍表现为鼻塞或空气进入鼻孔困难的症状。这些症状出现在切除部位位于鼻翼皱襞与鼻外侧壁交界处的病例中。伤口瘢痕挛缩会抬高鼻翼边缘，导致鼻翼软骨和外侧软骨向内移动，在鼻前庭外侧壁形成一个可见且可触及的嵴。鼻翼软骨和外侧软骨的这种移位以及这些软骨之间形成的坚硬瘢痕使鼻瓣无法活动。由于预防鼻瓣功能障碍比后期修复更容易，对于跨越鼻翼皱襞或位于鼻翼或外侧壁且距鼻翼皱襞1毫米以内、总直径为1.0厘米的伤口，应进行修复以预防鼻瓣功能障碍。在修复深部缺损的过程中，鼻翼软骨外侧脚与外侧软骨的重叠区域可用耳甲软骨移植来稳定。这种软骨移植可与前额皮瓣重建鼻皮肤及修复鼻内衬一起使用。如果鼻内衬完整，软骨移植可与全厚皮片一起使用。
