内镜辅助下筛骨垂直板切取术在短鼻整形中的应用

Abstract

目的 探讨内镜辅助下筛骨垂直板切取术在短鼻整形中的应用.方法 在内镜辅助下,对30例拒绝取肋软骨且鼻中隔量不足的短鼻女性患者(18～36岁)行筛骨垂直板及软骨的切取,用筛骨垂直板剪刀分别距离背侧5～7 mm和距离犁骨2～3 mm剪开筛骨垂直板,并用筛骨垂直板咬骨钳咬除部分筛骨垂直板,准备鼻综合手术用作加固保留原有的L形鼻中隔软骨支架及加固延伸或支撑移植物.结果 内镜能清楚显示筛骨垂直板及鼻中隔软骨的结构,切取更加精确和容易.无一例感染、出血等并发症.30例随访6～12个月,平均8个月,均未发现鼻中隔穿孔、脑脊液漏和鼻背塌陷.29例对鼻形态满意,轮廓自然,1例术后自觉鼻背高度不够.结论 对拒绝取肋软骨且鼻中隔量不足的短鼻患者,内镜辅助下筛骨垂直板切取作为鼻中隔软骨的辅助移植物,补充软骨量不足,有助于获得良好的手术效果,安全可行.

Objective To evaluate the application value of endoscopic technique in resection of perpendicular plate of ethmoid bone. Methods Under endoscopic assistance , 30 women (aged 18-30 years old) with short nose deformities who refused to costal cartilage harvesting and had insufficient nasal septum underwent cartilage and perpendicular plate of ethmoid bone resection .The perpendicular plate of the ethmoid bone was opened along the line 5-7 mm away from the dorsal part and 2-3 mm from the vomer by using perpendicular plate scissors .Part of perpendicular plate was removed with bone rongeur in order to reinforce the L -shaped nasal septum cartilage and strengthen the extension or graft . Results The use of endoscope offered a clear view of the perpendicular plate of ethmoid bone and allowed the surgeon to resect perpendicular plate of ethmoid bone more easily .No postoperative complications such as infection or bleeding .The 30 patients were followed up for 6 -12 months, with an average of 8 months.No perforation, cerebrospinal fluid leakage , or dorsal depression was detected .Twenty-nine patients were satisfied with the nasal morphology with normal contour , and one patient complained of low nasal dorsum height . Conclusion For those refuse to costal cartilage harvesting and have insufficient nasal septum , endoscopic-assisted resection of perpendicular plate of ethmoid bone is feasible , safe and effective .