Zeng W T, Yang J H, Chen J, Jiang H L, Ma N J, Qian Y
Department of Otorhinolaryngology Head and Neck Surgery, Daping Hospital, Army Medical University, Chongqing 400042, China.
Department of Otorhinolaryngology, Longling Country People's Hospital, Baoshan 678300, Yunnan Province, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020 Mar 7;55(3):217-222. doi: 10.3760/cma.j.issn.1673-0860.2020.03.006.
To explore the application and effect of autologous cartilage in rhinoplasty for patients with traumatic hernia and nasal dysfunction. From January 2017 to April 2019,30 patients with nasal trauma admitted to Department of Otorhinolaryngology Head and Neck Surgery, Daping Hospital, Army Medical University were treated for 6 days to 14 years. All patients were accompanied by different degrees of nasal deformity and nasal ventilatory disorders. They were classified into three categories: light, medium and heavy. All of them were open at the same time. Rhinoplasty and nasal septum deviation correction. For mild to moderate nasal deformity and nasal ventilatory disorders, ear cartilage was used to modify the tip of the nose and strengthen the nasal septal cartilage support to modify the deformity of the nasal back. For severe nasal deformity and nasal ventilatory disorders, we engraved the costal cartilage into a "Y" shaped monolithic stent or flank costal cartilage to form a 2+1 or 4+1 stent, and the costal cartilage stent and the septal cartilage tail end were sutured. Reshape the nasal septum frame support and the nasal column to avoid collapse of the nose. Three patients had a septal hematoma after operation and recovered normally after cleansing. All patients were followed up for 2 months to 2 years, and no complications such as nasal septum perforation and nasal bridge collapse occurred. The postoperative cure rate was 60.0% (18/30). All patients had a grade I nasal drop after surgery, and the effective rate was 100% (30/30). The patient's preoperative measurement deviation was (6.85±2.43) mm, the postoperative measurement deviation was (2.4±1.58) mm, the preoperative nasal appearance VAS score was (1.93±1.31), and the postoperative nasal appearance VAS score was (6.60±1.16), the difference in facial appearance deviation and VAS score before and after surgery was statistically significant (0.05). All patients had improved nasal ventilation after operation. The preoperative nasal ventilation VAS score was (1.97±1.07), the postoperative nasal ventilation VAS score was (6.53±1.04), and the difference between preoperative and postoperative nasal ventilation VAS scores was statistically significant (0.05). Autologous cartilage is effective in rhinoplasty in patients with traumatic nasal contraction and nasal dysfunction. One stage open rhinoplasty and nasal septum deviation surgery are performed to shorten the treatment time and improve the nasal appearance and nasal ventilation function. The patients got satisfaction.
探讨自体软骨在创伤性鼻畸形及鼻功能障碍患者鼻整形术中的应用及效果。2017年1月至2019年4月,陆军军医大学大坪医院耳鼻咽喉头颈外科收治的30例鼻外伤患者,病程6天至14年。所有患者均伴有不同程度的鼻畸形及鼻通气障碍,按轻重程度分为轻、中、重三类,均同期行开放鼻整形及鼻中隔偏曲矫正术。对于轻、中度鼻畸形及鼻通气障碍,采用耳软骨修饰鼻尖、加强鼻中隔软骨支撑以矫正鼻背畸形;对于重度鼻畸形及鼻通气障碍,将肋软骨雕刻成“Y”形整体支架或双侧肋软骨形成2+1或4+1支架,将肋软骨支架与鼻中隔软骨尾端缝合,重塑鼻中隔框架支撑及鼻小柱,避免鼻背塌陷。术后3例出现鼻中隔血肿,经清理后恢复正常。所有患者随访2个月至2年,均未发生鼻中隔穿孔、鼻梁塌陷等并发症。术后治愈率为60.0%(18/30)。所有患者术后鼻滴漏均为Ⅰ级,有效率为100%(30/30)。患者术前测量偏差为(6.85±2.43)mm,术后测量偏差为(2.4±1.58)mm,术前鼻外观VAS评分为(1.93±1.31),术后鼻外观VAS评分为(6.60±1.16),手术前后面部外观偏差及VAS评分差异有统计学意义(P<0.05)。所有患者术后鼻通气均改善,术前鼻通气VAS评分为(1.97±1.07),术后鼻通气VAS评分为(6.53±1.04),术前与术后鼻通气VAS评分差异有统计学意义(P<0.05)。自体软骨用于创伤性鼻挛缩及鼻功能障碍患者鼻整形术效果良好,同期行开放鼻整形及鼻中隔偏曲手术可缩短治疗时间,改善鼻外观及鼻通气功能,患者满意度高。