Cho B C, Lee J H, Cohen M, Baik B S
Department of Plastic and Reconstructive Surgery, Kyungpook National University Hospital, Taegu, Korea.
J Craniofac Surg. 1998 Jan;9(1):20-9. doi: 10.1097/00001665-199801000-00006.
Fifty-five patients with unilateral cleft lip nasal deformities were operated on from March 1992 to June 1996. Thirty-one patients were male and 24 were female. Three patients were 2 to 5 years of age, 7 patients were 6 to 10 years old, 12 patients were 11 to 15 years old, 13 were 16 to 20 years old, and 20 were greater than 21 years of age. The average follow-up period was 16 months. Combined operative procedures, depending on the severity of the cleft lip nasal deformity, were the following: (1) a reverse-U incision and Z-plasty for a mild vestibular web, (2) a reverse-U incision and V-Y plasty for a moderate vestibular web, (3) open rhinoplasty incision combined with a reverse-U incision and V-Y plasty for severe flattening or buckling of the cleft lower lateral cartilage, (4) lower lateral cartilage suspension or repositioning with or without an onlay cartilage graft, (5) alar base advancement, (6) bone graft on the piriform aperture, (7) septoplasty and corrective rhinoplasty, and (8) columella lengthening with an auricular composite graft. A nasal splint was applied for 3 to 6 months in every patient to maintain the corrected nostril contour. Most patients were satisfied with their surgical results. We suggest that to achieve a good contour of the nose, bony and cartilaginous deformities should be corrected simultaneously with correction of the soft tissue.
1992年3月至1996年6月，对55例单侧唇裂鼻畸形患者进行了手术。其中男性31例，女性24例。3例患者年龄在2至5岁之间，7例患者年龄在6至10岁之间，12例患者年龄在11至15岁之间，13例患者年龄在16至20岁之间，20例患者年龄大于21岁。平均随访期为16个月。根据唇裂鼻畸形的严重程度，联合手术步骤如下：（1）对于轻度前庭蹼，采用倒U形切口和Z成形术；（2）对于中度前庭蹼，采用倒U形切口和V-Y成形术；（3）对于严重扁平或弯曲的裂侧鼻翼软骨，采用开放式鼻成形术切口联合倒U形切口和V-Y成形术；（4）采用或不采用植入软骨移植进行鼻翼软骨悬吊或复位；（5）鼻翼基底推进；（6）梨状孔植骨；（7）鼻中隔成形术和矫正鼻成形术；（8）采用耳廓复合移植延长鼻小柱。每位患者均佩戴鼻夹板3至6个月，以维持矫正后的鼻孔外形。大多数患者对手术效果满意。我们建议，为了获得良好的鼻外形，在矫正软组织的同时应同时矫正骨和软骨畸形。
