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Intranasal Z-plasty to Correct Internal Nasal Valve Stenosis: A Case Report
鼻內Z-字型成型術矯治內鼻閥狹窄：案例報告
摘要
鼻閥是決定鼻道內氣流屬性的關鍵結構，鼻閥範圍產生的氣渦流不僅調節呼吸，也控制溫度、濕度與過濾吸入的空氣。鼻閥的狹窄對病人而言，不只是外觀上的、也是功能上問題。即使是輕微的鼻閥狹窄也能引起顯著、且造成困擾的鼻道內氣渦流改變。目前有許多手術的方式，從微創性的縫合術到侵襲性的開放式鼻整形術，可以利用來治療與改變鼻閥區的狹窄程度。人們常不願意嘗試手術矯治，乃是因為常規的鼻整形手術法，常常需要明顯的切割傷口、或是應用軟骨移植，而且有高度復發性與鼻外觀變型的風險。許多有鼻閥狹窄的病人並不想要複雜的手術法、用軟骨移植增強，更不願意被鼻型重建。本篇文章為了這群病患提供一種微創性的手術方式，鼻內Z-字型成型術；這個術式已經有完整的文獻記載來應用於真性鼻閥狹窄，也用來修補唇額裂變型以及重建變窄和塌陷性的內鼻閥角。本文我們報告一位25歲女性，因為之前兒童期的臉部外傷後造成內鼻閥部變形狹窄。一年前經由鼻內Z-字型成型術來矯治此一疾病。因而成功地阻止鼻閥變窄之復發，也使得鼻翼和鼻孔有達到容貌上對稱性。
並列摘要
The nasal valve plays a crucial role in determining airflow characteristics of the nasal airway. In addition to respiration, the airflow turbulence created in this region regulates temperature, humidification, and filtration of inspired air. Stenosis of the nasal valve is not only esthetic but also a functional problem for the patient. Even mild stenosis can result in significant and problematic changes in airflow. There are several surgical approaches available to treat and improve constriction in the nasal valve region, from minimally invasive suture techniques to considerably more invasive open rhinoplasty approaches. Surgical correction is often not attempted because conventional surgical techniques require significant surgical dissection or cartilage grafting and have a high risk of relapse and external nasal deformity. Several patients with nasal valve stenosis do not desire a complex procedure, do not need cartilage augmentation, or do not want nose reshaping. For these patients, intranasal Z-plasty, a minimally invasive approach, has been well described to achieve true stenosis within the nasal valve, repair of cleft lip nasal deformities, and repair of narrowing and collapse of the internal nasal valve angle. We present the case of a 25-year-old female who had left-side internal nasal valve stenosis after facial trauma at childhood that was corrected by intranasal Z-plasty 1 year previously. Follow-up has shown that the stenosing process has not recurred and that an esthetically symmetrical aspect of the alar wings and nostrils was achieved.