Objective: ?To explore the effectiveness of transplantation of engraved autologous costal cartilage for individualized surgical management in secondary rhinoplasty for cleft lip.
Methods: ?Between September 2009 and January 2014, 350 patients with secondary nasal deformity of cleft lip were treated, including 160 males and 190 females with a mean age of 18.2 years (range, 16-56 years). Nasal deformity was caused by unilateral cleft lip in 200 cases and by bilateral cleft lip in 150 cases. The interval of lip repair and nasal deformity correction was 2-50 years (mean, 12 years). About a 2-6 cm cartilage was harvested from the 6th or 7th costal cartilage, and was engraved to the shape of "ge" in Chinese. The upper part was strengthened on both sides of the alar cartilage; the lower part was fastened to columella and nasal septum cartilages. The rest of cartilages was diced into 0.1 mm×0.1 mm×0.1 mm cubes. The columella incision was designed to "Z"-plasty, and was stretched to the nasion along alar edge. The engraved autologous costal cartilage was transplanted and fixed to the collapse of nostril. The cartilage cube was transplanted and filled into the collapse of nasal root to achieve the aesthetic effect of nasal augmentation. The effectiveness was evaluated according to the grade of secondary rhinoplasty for cleft lip by ZHANG Li et al. at 1, 6, and 12 months after operation.
Results: ?All incisions were primary healing. All patients were followed up 1-12 months (mean, 6 months). After rhinoplasty, the collapse of nostrils was lifted, and the shape and height of collapse of nostrils were symmetrical to normal side. The deflection of columella nasi was corrected. A beautiful shape of nose was achieved. The excellent and good rates were 98.6% at 1 month, 97.4% at 6 months, and 97.1% at 12 months after operation, showing no significant difference (χ2=0.545, P=0.761).
Conclusions: ?The technique of transplantation of engraved autologous costal cartilage for individualized surgical management in secondary rhinoplasty for cleft lip can achieve excellent surgery effect.
目的: 探讨采用自体肋软骨雕刻行唇裂术后继发鼻畸形个体化治疗的手术方法及疗效。.
方法: 2009年9月-2014年1月收治唇裂术后继发鼻畸形患者350例，其中男160例，女190例；年龄16～56岁，平均18.2岁。单侧唇裂术后鼻畸形200例，双侧150例。唇裂手术至鼻畸形矫形手术时间间隔2～50年，平均12年。术中取患者同侧或对侧第6或第7肋软骨2～6 cm，将肋软骨拼接并雕刻成“个”字形结构，其中上半部的“人”作为两侧鼻翼软骨的加强，下半部的“1”作为鼻小柱及鼻中隔软骨的加强，剩余肋软骨切碎成0.1 mm×0.1 mm×0.1 mm大小颗粒。采用鼻小柱阶梯状切口，将拼接并雕刻成“个”字形的肋软骨移植于鼻翼塌陷侧，同时将剪成颗粒状的肋软骨注射填充入鼻背部，达到隆鼻效果。术后1、6、12个月，参照张莉等的唇裂继发鼻畸形修复疗效评价标准评价手术疗效。.
结果: 术后患者切口均Ⅰ期愈合。350例均获随访，随访时间1～12个月，平均6个月。术后患者患侧塌陷鼻翼得到提升，与健侧鼻翼高度基本一致，鼻孔形态基本对称，同时鼻小柱歪斜纠正，鼻梁塌陷得到很大改善，鼻部形态基本协调，效果美观。术后1、6、12个月患者疗效评价优良率分别为98.6%、97.4%、97.1%，比较差异均无统计学意义（χ2=0.545，P=0.761）。.
结论: 采用自体肋软骨雕刻行唇裂术后继发鼻畸形个体化治疗，能够取得良好的手术效果。.
Keywords: Autologous costal cartilage; Cleft lip; Individualized surgical management; Nasal deformity.