利用鼻內骨切開術施行鼻成形術

Endonasal Osteotomy in Rhinoplasty

涂智文(Chih-Wen Twu) ； 梁凱莉(Kai-Li Liang) ； 江榮山(Rong-San Jiang) ； 蘇茂昌(Mow-Chan Su) ； 辛宗翰(Jon-Han Sin)

《台灣耳鼻喉頭頸外科雜誌》 44卷3期 (2009/06) Pp. 73-78

https://doi.org/10.6286/2009.44.3.73

摘要

背景：適當的鼻骨切開術是鼻成形術成功的重要因素。變形的骨性鼻錐部可由鼻內連續性或鼻外穿透性的鼻骨切開術加以矯正。我們報告鼻成形術中利用鼻內骨切開術矯正鼻變形之經驗。
方法：本研究回溯性收集包含自2004年8月至2008年7月間在台中榮總耳鼻喉部接受鼻成形術的患者中曾接受鼻內骨切開手術者共64名。病患於手術前均經完整病史詢問、耳鼻喉科理學檢查、鼻內視鏡檢查。另安排術前攝影，接受臉部正面、雙側側面、雙側45 斜面及臉部底部之6張照相記錄。手術採全身麻醉，施行鼻內骨切開術予以矯正鼻錐部變形，術後鼻外部以手術膠帶及石膏固定，於門診定期追蹤並接受術後照相記錄。
結果：64名患者中男性佔43名，女性佔21名；平均年齡爲31.5歲。鼻內骨切開術式包括斜位骨切開術29名，外側截骨術加橫向骨切開術15名，外側骨切開術加內側骨切開術20名。手術後平均追蹤期間爲12.5個月。手術後1週內併發症包括鼻周腫脹60名，鼻周疼痛32名，鼻周瘀青26名，眼周腫脹感6名，溢淚3名。3個月後仍存在的術後併發症包括間歇性刺痛感1名以及矯正後之殘餘性變形3名。
結論：藉由對骨性鼻錐的移動與重置，鼻骨切開術可用於側鼻輪廓修飾、鼻底部縮小及掀頂式變形矯正等狀況。術後不適感大多能在休養後恢復。矯正後再變形主要因爲術後外固定未能確實。

關鍵字

彎曲鼻 ； 鼻變形 ； 鼻外傷 ； 骨切開術 ； 鼻成形術

並列摘要

BACKGROUND: Nasal osteotomies are essential for successful rhinoplasty. Deformed nasal bony vault can be corrected by proper nasal osteotomies via internal continuous or external perforated method. We present our experiences with internal osteotomies in conducting rhinoplasty for making refinement to nasal deformity.
METHODS: From August 2004 to July 2008, 64 patients who received internal
osteotomies in Taichung Veterans General Hospital were enrolled in this retrospective study. All the patients went through history taking, physical examination and nasal endoscopy. Preoperative photographic records include frontal view, bilateral lateral view, bilateral oblique view and basal view. Nasal deformities were corrected by osteotomies under general anesthetic. External fixation with surgical tape and orthopedic casting tape was maintained for one week. Regular follow-up with postoperative photographic records was performed.
RESULTS: Among the 64 patients, 43 were males and 21 were females. The average age was 31.5 years old. Performed internal osteotomies included 29 oblique osteotomies, 15 lateral along with transverse osteotomies and 20 lateral along with medial osteotomies. Average postoperative follow-up period was 12.5 months. Immediate postoperative complications within one week include perinasal swelling (60 patients), perinasal pain (32 patients), perinasal ecchymosis (26 patients), periorbital swelling (6 patients) and epiphora (3 patients). Most of the complications disappeared within 3 months except intermittent tingling sensation in one patient and residual deformity in three patients.
CONCLUSION: By mobilizing and repositioning the bony pyramid, nasal osteotomies can reshape the lateral nasal contour, narrow the nasal base, and correct a open roof deformity. Most of the postoperative complications can recovered after a period of time. The residual deformity can result from insecure external fixation.

並列關鍵字

deviated nose ； nasal deformity ； nasal trauma ； osteotomy ； rhinoplasty