鼻内镜下四线减张法鼻中隔整形-鼻整形

鼻内镜下四线减张法鼻中隔整形-鼻整形

王丰周成勇

【摘要】目的探索鼻内镜下四线减张法鼻中隔整形-鼻整形矫正由鼻中隔基本平直但偏离中线引起的外鼻软骨锥段歪鼻。方法选择2009年12月至2011年4月由鼻中隔偏曲引起的软骨段歪鼻和鼻尖部畸形的患者17例，根据方形软骨偏曲的特点分为4型：方形软骨前缘脱位偏曲型，鼻尖歪向方形软骨脱位侧；方形软骨前后偏曲型，外鼻软骨锥段偏斜，与鼻骨呈钝角，鼻尖歪向方形软骨脱位侧；方形软骨后缘偏曲型，鼻背呈C形或反C形歪曲；方形软骨上下偏曲型，鼻背偏向一侧。根据鼻中隔偏曲的不同类型，制订相应的手术方案：在鼻内镜下经鼻内进路分离方形软骨与周围骨、软骨和鼻小柱的连接，调整方形软骨与周围骨和软骨的连接方式，去除连接处多余骨或软骨条，即通过方形软骨前缘、下缘、后缘、上缘四线减张法达到鼻中隔整形同期鼻整形的目的。结果17例患者全部取得了良好的疗效，既解决了鼻塞问题，又改善了鼻外形，未见并发症。结论在鼻内镜下四线减张法鼻中隔整形-鼻整形可以矫正由方形软骨偏曲引起的歪鼻。

【关键词】内窥镜检查；耳鼻喉外科手术；鼻整形；鼻中隔；四线减张；歪鼻

Four line tension relaxing septo-rhinoplasty on nasal deviation complicated with the deformity of nasal septal cartilage under endoscopy WANG Feng, ZHOU Cheng-yong.Department of Otorhinolaryngology, First Appertaining Hospital of Chinese People’s Liberation Army General Hospital, Beijing 100048, China

Corresponding author: WANG Feng, Email: wangfeng304@

【Abstract】Objective To explore the four line tension relaxing septo-rhinoplasty on nasal deviation complicated with the deformity of nasal septal cartilage under endoscopy. Methods The patients were divided into different groups depending on different deformity of quadrangular cartilage. Different surgeries were made according to different deviation of nasal septum. First cut a C-shape or L-shape incision on one side of the nasal septum under endoscopy, then separated the nasal septum cartilage from the angle formed by two greater alarcartilages, perpendicular plate of the ethmoid bone, the junction of vomer and maxilla at the nasal crest, and the upper lateral cartilage, this procedure was applied to correct deviation of nasal septum and nasal pyramid by decompression, which was named four lines tension relaxing correction. Results Seventeen cases of nasal deviation patients obtained satisfied curative effect. Nasal deviation and deviation of nasal septum were all corrected, and patients got better appearance and good nasal ventilation, no complication was observed. Conclusion Nasal deviation complicated with the deformity of nasal septal cartilage patients could be completely rectified by only one

septorhinoplasty operation- four lines tension relaxing correction.

【Key words】Endoscopy; Otorhinolaryngology surgery procedure; Nasal septum; Four-cut sheets; Nasal endoscopy, Rhinoplasty, Nasal deviation

歪鼻，大多伴随着鼻中隔偏曲，尤其是软骨锥歪曲，基本上由鼻中隔偏曲引起。鼻中隔的形态决定鼻梁的形态[1]。对于由鼻中隔偏曲引起的歪鼻，既要解决通气功能，还要改善外鼻形状。整形科医生和耳鼻咽喉头颈外科医生对此都做了许多工作，取得了较好的效果[2-7]。对于鼻中隔软骨本身尚平直，但偏离中线，并与鼻中隔后段相交成钝角或者鼻中隔软骨前下缘脱位而引起的软骨段歪鼻者，鼻科界前辈通过转门法手术，同时矫正鼻中隔偏斜、鼻中隔软骨脱位及歪鼻[8]。对鼻中隔方形软骨本身平直但与周围骨与软骨连接偏曲而引起的软骨段歪鼻和由于方形软骨前下缘向一侧鼻腔脱位引起的鼻尖部畸形者，笔者在鼻内镜下三线减张法矫正鼻中隔的基础上，进一步分离方形软骨与鼻背软骨和鼻小柱的连接，根据需要，骨折、条形切除连接处的骨、软骨，使方形软骨与周围骨、软骨平直对接并居于中线，即四线减张-复位法，同时矫正了鼻中隔和软骨段歪鼻以及鼻尖部畸形，现回顾总结，介绍如下。

资料和方法

一、临床资料

2009年12月至2011年4月我科住院的鼻中隔偏曲引起的软骨段歪鼻和鼻尖部畸形的患者17例，年龄16～40岁，均为男性。其中经传统的鼻中隔黏膜下切除术后鼻通气功能和外形改善不佳者2例，幼年或成年后有明确鼻部外伤史者5例。

二、方法

根据鼻中隔方形软骨偏曲的情况进行分类手术。

1．方形软骨前缘脱位：患者表现为鼻尖歪向方形软骨脱位侧甚至低平，前鼻孔不对称，外鼻锥体底部呈不等腰三角形（图1a，1b-1）。

2．方形软骨前后偏曲：方形软骨前缘和前下缘偏向一侧鼻腔并脱位，后缘向对侧偏曲，与筛骨垂直板成钝角连接，即方形软骨由前向后呈斜形。患者表现为歪鼻，即软骨锥直线型偏斜，与鼻骨成钝角连接，鼻尖偏向方形软骨前缘脱位侧（图2a,2b,2c-1）。

3．方形软骨后缘偏曲：方形软骨前缘和前下缘不脱位且平直，但后上缘及后缘与筛骨垂直板成钝角，合并或不合并上颌骨鼻嵴的骨棘或嵴。患者鼻背与鼻中隔钝角相应呈C形或反C形歪曲状态（图3a）。

4．方形软骨上下偏曲：即方形软骨鼻背侧偏向一侧鼻腔而鼻底侧偏向另一侧鼻腔，外鼻锥体底部呈不等腰三角形。这类鼻中隔偏曲合并歪鼻主要由幼年时的外伤引起（图4a,4b,4c-1）。

二、手术要点

1．切口：对方形软骨前缘无脱位者，切口均做在左侧鼻腔，如同传统的Killian 切口。如果