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頁籤選單縮合
題名 | Reconstruction of Saddle Nose Deformity Using Autogenous Rib Cartilage Grafts=使用自體肋軟骨重建鞍型鼻 |
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作者 | 廖國鈞; 黃國峯; 劉澄; 楊振; 林聿山; 陳俊嘉; | 書刊名 | 臺灣整形外科醫學會雜誌 |
卷期 | 22:4 2013.12[民102.12] |
頁次 | 頁284-295 |
分類號 | 416.87 |
關鍵詞 | 鞍型鼻; 肋軟骨; Saddle nose deformity; Costal cartilage graft; Rhinoplasty; |
語文 | 英文(English) |
中文摘要 | 背景:鞍型鼻特點是鼻背呈現凹陷,鼻外觀會有變短的情況。由於鼻部是顏面最凸起、明顯之處,鞍型鼻會嚴重影響美觀,破壞臉部和諧的比例。由於鼻背塌陷,病人的呼吸功能也常受損。鞍型鼻會有不同程度的凹陷畸形,原因包括外傷、感染、醫源性(先前的鼻部手術)或先天性畸形。手術目標是重建適當外觀、恢復呼吸功能。重建方式必須使用充填物。在各種充填材料中,自體組織適合用在外傷或感染造成的鞍型鼻。由於必須依據病人需求,將軟骨塑造成適合形狀,以及重建鼻部的支撐力道。所以在此類重建需要多量自體軟骨,而肋軟骨可以滿足重建鞍型鼻的各種需求。目的與目標:研究我們醫院的臨床經驗。詳細的術前評估,配合適當手術方式,包含肋軟骨的拿取、塑型與開放式鼻整形技巧,可提供鞍型鼻病人穩定的手術結果。材料及方法:在本院使用自體肋軟骨重建鞍型鼻的病人是研究對象。利用回溯性方式,分析病人年齡、病史、鞍型鼻機制、理學檢查、實驗室檢查結果、手術方式,以及相關併發症的記載,得到相關數據後運用研究。所有病人均是在全身麻醉下利用開放式鼻整形的手術方法治療。結果:我們分析六位病人,三位男性三位女性。五位病人由於外傷導致後續的鞍型鼻變化,一位病人是由於感染導致鞍型鼻。病人在術後鼻外觀與功能均有改善。術後追蹤發現傷口癒合穩定,沒有鼻部感染、皮膚壞死、氣胸等其他併發症。在經過一段時間的追蹤,鼻部沒有呈現明顯彎曲或肋軟骨吸收的變化。結論:在鞍型鼻病人的治療,術前詳細的病史詢問與理學檢查很重要,為分析鞍型鼻發生機制的資訊來源。使用肋軟骨的優點包含足夠的軟骨量、適當的重建支撐力道,以及低感染率。手術步驟必須仔細,避免氣胸等併發症。在修整、塑型肋軟骨時,運用適當的手術技巧,可以減少軟骨彎曲的變化。肋軟骨的使用,配合適當的治療計畫,可以讓鞍型鼻病人恢復外觀與呼吸功能。 |
英文摘要 | Background:Reconstruction of saddle nose deformity is challenging, especially in trauma or revisional patients. The surgical goals are aesthetic and functional reconstruction of the dorsum. Autologous tissues are mandatory in these circumstances. Septal and auricular cartilages are inadequate for major dorsal augmentation. Costal cartilages can maintain their volume in the long term, be easily harvested and carved, and be used successfully in dorsum augmentation.Aim and Objectives:The purpose of the retrospective study was to review our experience with using autologous rib cartilage in reconstructive rhinoplasty for saddle noses. The donor site morbidities and warping of carved costal cartilage autografts could be minimized when adequate surgical maneuvers were applied. We sought to determine costal cartilages could be ideal in terms of safety during harvesting, available amount of length and caliber, and consistent long-term results.Materials and Methods:A sample of six patients with saddle nose deformity who underwent dorsum reconstruction was selected. Information concerning patient characteristics, medical history, operative procedures, and complications was collected by consultation of all medical records. The patients were operated under general endotracheal anesthesia. Open rhinoplasty approach via trancolumellar incision was performed. All the graft sources were from costal cartilages.Results:Three patients were male and three were female. The age range was between 15 and 65 years. The indications for the surgery were five posttraumatic deformities, and the remaining one was attributable to infection. Overall, satisfactory functional and aesthetic outcomes were achieved by autogenous costal cartilage. There was no evidence of infection, graft migration or warping, or significant absorption. Adequate nasal projection and symmetry were obtained during follow-up period.Conclusion:It is very important to do preoperative detailed history taking and physical examination in these patients. Reconstruction of saddle nose deformity requires solid structural support. Use of autogenous costal cartilage is well accepted due to several advantages, including minimal risks of extrusion or infection, as well as ease of harvest and carving. Those advantages were all present in our series. Surgical techniques including balanced cross-sectional carving, atraumatic harvest, and insertion of k-wires into the graft can significantly reduce the incidence of cartilage warping. Autogenous rib cartilage can provide ample volume and achieve satisfactory outcomes both functionally and esthetically in dorsum reconstruction. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。