Primary correction of the unilateral cleft nasal deformity
Primary correction of the unilateral cleft nasal deformity
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DOI：
10.1097/00006534-200011000-00007
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发表时间：
2000-11-01
影响因子：
3.6
通讯作者：
Salomon, J
中科院分区：
文献类型：
--
作者：
Byrd, HS;Salomon, J
本文介绍了 18 年治疗 1200 名患者单侧鼻裂畸形的经验。在婴儿期唇部修复时进行了初级鼻裂矫正；青春期鼻部完全生长后进行二次鼻整形术。作者描述了初次鼻裂矫正的技术细节。通过旋转推进设计的切口获得曝光。皮肤包膜的软骨框架被广泛破坏。鼻衬从梨状孔释放，并通过旋转裂鼻翼下方的“肌肉卷”在裂侧创建新的上颌平台。然后使用从鼻翼软骨延伸到面部肌肉组织的床垫缝合线来处理鼻翼网。在 60% 的情况下，这些操作足以产生对称的圆顶投影和鼻孔对称。另外 40% 的患者，其特点是下外侧软骨裂口发育不全更严重，则使用了倒 U 形软骨下切口和鼻翼圆顶支撑缝合线 (Tajima) 至对侧上软骨。通过这种缝合可以最有效地处理下外侧软骨的残余背侧覆盖。这种治疗鼻裂畸形的主要方法可以使鼻翼和穹窿复合体更加平衡地生长和发育。学早期的一些心理创伤是可以避免的。此外，由于裂鼻软骨的早期重新定位，成人鼻整形术时解决的畸形不太严重，并且更容易获得最佳的最终结果。
An 18-year experience with the management of the unilateral cleft nasal deformity in 1200 patients is presented. A primary cleft nasal correction was performed at the time of lip repair in infancy; a secondary rhinoplasty was done in adolescence after nasal growth was complete. The technical details of the authors' primary cleft nasal correction are described. Exposure was obtained through the incisions of the rotation-advancement design. The cartilaginous framework was widely undermined from the skin envelope. The nasal lining was released from the piriform aperture, and a new maxillary platform was created on the cleft side by rotating a "muscular roll" underneath the cleft nasal ala. The alar web was then managed by using a mattress suture running from the web cartilage to the facial musculature. In 60 percent of cases, these maneuvers were sufficient to produce symmetrical dome projection and nostril symmetry. In the other 40 percent, characterized by more severe hypoplasia of the cleft lower lateral cartilage, an inverted U infracartilaginous incision and an alar dome supporting suture (Tajima) to the contralateral upper cartilage were used. Residual dorsal hooding of the lower lateral cartilage was most effectively managed with this suture. This primary approach to the cleft nasal deformity permits more balanced growth and development of the ala and domal complex. Some of the psychological trauma of the early school years may be avoided. Also, because of the early repositioning of the cleft nasal cartilages, the deformity addressed at the time of the adult rhinoplasty is less severe and more amenable to an optimal final result.