Rhinoplasty in Cocaine Abuse Patien--A Case Report

古柯鹼成癮病患鼻整形手術──病例報告

Chien-Wei Wu(吳建緯) ； Chuan-hsiang Kao(高全祥) ； Tim Mo Chen(陳天牧)

《臺灣整形外科醫學會雜誌》 33卷4期 (2024/12) Pp. 499-508

摘要

Background: The effects of chronic cocaine abuse are well known and widely described in the literature. The cocaine crystals, with their strong vasoconstrictive properties, lead to the constriction of the blood vessels of the lining mucosa and perforation of the septum which serves as an important supporting structure of the distal two-thirds of the nose. Aim and Objectives: Cocaine abuse will lead to chronic infection causing septal perforation and necrosis of nasal structures, resulting in collapse of the nose, also known as saddle-nose deformity. Materials and Methods: We present a successful reconstruction case, the patient with severe saddle nose deformity and septum perforation, caused by cocaine abuse. Rhinoplasty with rib and ear cartilage achieved acceptable functional and aesthetic result. Results: Post operative follow-up showed acceptable functional and cosmetic results. Conclusion: Rhinoplasty of cocaine abuse nose with rib graft and ear cartilage is technically tedious, but can achieve better result than alloplastic material.

關鍵字

Cocaine nose ； Rhinoplasty ； Rib graft ； Ear cartilage

並列摘要

背景：古柯鹼濫用的影響在文獻中已被廣泛描述。古柯鹼具有強烈的血管收縮特性，導致黏膜內血管收縮和鼻中隔穿孔，鼻中隔則是鼻部末端三分之二的重要支撐結構。目的與目標：古柯鹼濫用將導致慢性感染，引起鼻中隔穿孔和鼻部結構壞死，進而導致鼻塌陷，即所謂的馬鞍鼻畸形。材料與方法：此報告為國內因古柯鹼濫用而引起嚴重馬鞍鼻畸形和鼻中隔穿孔，尋求鼻整形的病例。透過用自體肋軟骨和耳軟骨移植進行的重建手術，手術步驟：一、取右側第七肋骨及耳軟骨，二、利用肋軟骨雕塑出Ｌ型支撐鼻背和鼻小柱支撐結構（Dorsal strut and Columella strut），三、楔形移植（Spreader Graft）增加強度，四、最後利用耳軟骨增加鼻頭的圓潤度，達到了令人滿意的功能和美觀效果，同時也整理討論國際上相似案例與此個案的異同之處。結果：手術後三個月追蹤，顯示出令人滿意的功能和美容效果。結論：對於古柯鹼濫用所致鼻部問題，使用自體肋骨移植和耳軟骨進行整形手術在技術上較複雜，但相較於植入人工合成材料，既能取得更好的效果，也較不會有感染的疑慮，為合理的選擇。