Markey Jeff, Seth Rahul, Knott P Daniel
Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, USA.
Am J Otolaryngol. 2015 Jul-Aug;36(4):499-502. doi: 10.1016/j.amjoto.2015.04.002. Epub 2015 Apr 18.
Patients having suffered severe nasal trauma or having undergone prior septal surgery present particular problems during open structure septorhinoplasty. Septal cartilage deficient noses often require costal or conchal cartilage grafting or the use of allograft material, resulting in secondary donor site morbidity, longer operative times and variable results. The present study evaluated the utility of cyanoacrylate-based adhesives (CBA) in creating layered septal cartilage grafts from remnant septal cartilage for L-strut reconstruction during open septorhinoplasty.
A retrospective clinical review was performed at a university-based facial plastic and reconstructive surgical practice, identifying patients undergoing open structure septorhinoplasty performed by the senior authors. Procedures involved construction of a layered caudal or dorsal L-strut graft from at least two smaller autologous septal cartilage grafts. The grafts were adhered together with CBA with 5-0 polydioxanone suture (Ethicon, Somerville, NJ) used for reinforcement. Stability of the final construct was assessed postoperatively.
Fifteen patients were included with mean age of thirty-nine years (range: 15-65). Fifty-three percent of the patients had undergone prior nasal surgery: Seven had undergone at least one prior external septorhinoplasty and one had undergone prior endonasal septoplasty. Median follow-up was 144 days (range: 45-405). Postoperatively, one local infection was noted and two patients complained of post-operative columellar deviation. No other complications were encountered.
CBAs provide a safe technique in the crafting of layered grafts to provide reliable tip/dorsal support when performing open structure septorhinoplasty among patients with cartilage deficient or severely traumatized septa.
遭受严重鼻外伤或先前接受过鼻中隔手术的患者在开放式鼻中隔鼻整形术中存在特殊问题。鼻中隔软骨缺损的鼻子通常需要肋软骨或耳甲软骨移植或使用同种异体材料，这会导致供体部位出现继发性并发症、手术时间延长且效果不一。本研究评估了基于氰基丙烯酸酯的粘合剂（CBA）在开放式鼻中隔鼻整形术中从残余鼻中隔软骨创建分层鼻中隔软骨移植物用于L形支柱重建的效用。
在一家大学面部整形和重建外科诊所进行了一项回顾性临床研究，确定由资深作者进行开放式鼻中隔鼻整形术的患者。手术包括从至少两个较小的自体鼻中隔软骨移植物构建分层的尾侧或背侧L形支柱移植物。移植物用CBA粘合在一起，并用5-0聚二氧杂环己酮缝线（Ethicon，萨默维尔，新泽西州）进行加固。术后评估最终结构的稳定性。
纳入15例患者，平均年龄39岁（范围：15 - 65岁）。53%的患者先前接受过鼻部手术：7例至少接受过一次先前的外部鼻中隔鼻整形术，1例接受过先前的鼻内鼻中隔成形术。中位随访时间为144天（范围：45 - 405天）。术后，记录到1例局部感染，2例患者抱怨术后鼻小柱偏斜。未遇到其他并发症。
对于鼻中隔软骨缺损或严重创伤的患者，在进行开放式鼻中隔鼻整形术时，CBA为制作分层移植物以提供可靠的鼻尖/鼻背支撑提供了一种安全技术。
