摘要
背景：即使經驗豐富的醫師所施行的鼻成形手術仍有可能需要進行修正性手術。患者尋求修正性鼻成形手術的原因包括失誤的診斷、不當的手術技術、醫病間不良的溝通、不當的術後照顧等。方法：本研究收集曾接受過鼻成形手術，但仍因外觀性或功能性病變而接受修正性鼻成形手術的患者共137名，分析其病變特性及手術方式。結果：修正性鼻成形手術距離前次手術的平均時間為10.3個月。接受修正性鼻成形手術術後追蹤時間平均為24.5個月。尋求修正性鼻成形手術的原因純為外觀性病變者佔38.7%；純為功能性病變者佔29.9%；31.4%則合併有外觀性及功能性病變。外觀性病變以鼻部上三分之一最多，佔59.4%。功能性病變包含內鼻閥狹窄者佔69.0%，尾端鼻中隔彎曲者佔48.8%。之前手術曾使用自體移植物或人工植入物者佔32.9%。修正性鼻成形手術中使用自體軟骨修正變形之人數佔75.2%，沒有任何患者使用人工植入物。結論：患者尋求修正性鼻成形手術在外觀上以鼻部上三分之一病變最多，功能上病變則以內鼻閥狹窄為最多。以不同部位的自體軟骨進行鼻整形重建皆可以獲得良好結果。
並列摘要
BACKGROUND: Revision rhinoplasty may be necessary even if the primary rhinoplasty was performed by an experienced facial plastic surgeon. Requirements for revision rhinoplasty may come from misdiagnosis, improper surgical techniques, poor communication between the surgeon and the patient, and incautious postoperative care.METHODS: One hundred and thirty seven patients who ever received rhinoplasty but seeking for secondary septorhinoplasty were enrolled in this study. The characteristics of the deformities, and the techniques of revision procedures were analyzed.RESULTS: The average duration between primary and secondary rhinoplasty was 10.3 months. The average duration of postoperative follow-up was 24.5 months. Reasons for pursuing secondary rhinoplasty included aesthetic deformity (38.7%), functional deformity (29.9%), or both (31.4%). The most frequent aesthetic deformity located at upper third of the nose (59.4%), whereas the most frequent functional deformities were stenosis of internal nasal valves (69.0%) and followed by caudal septal deviation (48.8%). Autografts and implants were found to be used in previous surgery in 32.9% patients. 75.2% patients received reconstruction with autografts in secondary rhinoplasty, however, none of the patients received implant insertion.CONCLUSION: Deformed upper third of the nose was the most common aesthetic deformity and stenosis of internal valve was the most frequent functional deformity which drove the patient to seek for secondary rhinoplasty. Good surgical result could be achieved via careful reconstruction using autografts. The domestic data regarding secondary rhinoplasty can be used as references during clinical consultation.
延伸閱讀
- 高全祥、王興萬（2003）。開放式鼻成形術。台灣耳鼻喉頭頸外科雜誌，38(4)，153-160。https://doi.org/10.6286/2003.38.4.153
- 林之勛（2017）。鼻整形手術介紹。臨床醫學月刊，80(3)，491-493。https://doi.org/10.6666/ClinMed.2017.80.3.091
- 蕭宇哲、高全祥、王興萬（2004）。以開放式鼻成形術矯正創傷性鼻扭曲。台灣耳鼻喉頭頸外科雜誌，39(6)，222-230。https://doi.org/10.6286/2004.39.6.222
- Tsai, C. H., Liou, E. J. W., Chang, F. C. S., & Chen, P. K. T. (2012). 鼻軟骨矯正手術在單側唇顎裂病人接受塑鼻器之後鼻整形的效用. 臺灣整形外科醫學會雜誌, 21(4), 307-316. https://doi.org/10.7096/TJTSPS.201212.0307
- 李錦昇、黃威雄（2009）。Minimal Nasal Packing after Septomeatoplasty。台灣耳鼻喉頭頸外科雜誌，44(6)，171-175。https://doi.org/10.6286/2009.44.6.171