目的：探讨鼻内窥镜辅助利用口腔黏膜瓣复合鼻腔黏膜瓣修补鼻中隔穿孔的可行性。材料和方法:从2001～2006，采用鼻内窥镜辅助带蒂口腔前庭沟黏膜瓣复合鼻腔黏膜瓣修补巨大鼻中隔穿孔16例，其中10例使用带蒂口腔前庭沟黏膜瓣复合鼻中隔黏骨膜瓣，6例使用带蒂口腔前庭沟黏膜瓣复合带蒂下鼻甲黏骨膜瓣，术后随访5月～3年。结果：3例患者在鼻腔的后份边缘在内窥镜下可见明显穿孔，半年后复查，4例患者中隔残余穿孔，出院时11例患者感觉口腔黏膜瓣进入的鼻腔侧鼻阻明显增加，半年后这种感觉明显改善，所有患者术后头昏、头痛、鼻腔干燥的症状完全消失。结论：鼻内窥镜辅助利用口腔黏膜瓣复合鼻腔黏膜瓣修补鼻中隔穿孔的方法具有较大的临床应用价值。
Objective To evaluate the operative methods and therapeutic effects of nasal septum cartilage-sil ica gel complex for two-stage repair of nasal deformities of unilateral cleft l ip. Methods From June 2001 to June 2007, 38 cases of secondary nasal deformity and septum deviation of cleft l ip were treated with transplanting nasal septum cartilage-sil ica gelcomplex. Among of them, there were 21 males and 17 females, aging 14-23 years with an average of 17.6 years. All cases were with nasal deformities of unilateral cleft l ip, including 21 cases of complete cleft l ip and 17 cases of incomplete cleft l ip. The locations were left side in 26 cases and right side in 12 cases. Nasal deformities were columella nasi deflexion, flattened nasal tip, pteleorrhine and alanasi collapse. The patients received 1-4 times operations, and the interval of two operations was 3-10 years (mean 5.5 years). According to nasal deformity, the nasal septum cartilage of 1.8 cm × 1.2 cm was cut, and transplanted into the nose point phantom surface forming “the shield” to extend nose column and to raise the tip of the nose. At the same time the nasal tip fat-connective tissue flap graft with fat knot was given. After fixation, the nasal alar cartilage and soft tissues were reduced to normal position. Results Primary heal ing of the incisions was achieved in all cases. The nasal deformity was corrected. The postoperative follow-up period was 12-18 months with an average of 15.6 months. All the patients of regional cartilage scars had no compl ication. The figure of nose was sl inky, the height of apex of nose and the shape of nose was natural,the apex of nose, nasal ala, nostrils and nasal columella were satisfactory [(the results were satisfactory in 30 cases (78.9%), general in 8 cases (21.1%)]. The nose department overall esthetics shape was improved in all the patients, no compl ications of the phantom sl iding, shifting and exposure, hemorrhage and infection occurred. Conclusion The nasal septum cartilagesil ica gel complex to repair the nasal deformities of unilateral cleft l ip is an ideal operation style.
Twentytwo patients with deviation of nasal septum were treated by modified septorhinoplasty. The main points in the modification were:(1) The incision was curved instead of "L" shaped. It would avoid the disadvantage of having tension on the suture line and poor exposure;(2) Using triangle osteotomy to correct deviation of nasal septum, it was less traumatic and lessbleeding and better correction. The results from followup were as follows:18 good and 4 fair. The techniques and advantages of the modified procedure were discussed.
目的：采用高分辨多排螺旋CT研究鼻中隔和中鼻甲解剖变异，并评价它们对前组鼻副窦引流通道的影响。方法：回顾分析60例行鼻腔和副鼻窦高分辨多排螺旋CT检查患者的图像资料。 其中男35例，女25例，平均年龄42岁。所有受试者均采用16排螺旋CT机行高分辨容积扫描，层面从硬腭至额窦上缘，准直0.75~1 mm，横断、冠状和矢状重建，层厚及层距均为1 mm。分别观察和统计鼻中隔和中鼻甲解剖变异的类型和发生率，并评价其与前组鼻副窦引流通道的关系。结果：60例中，共发现鼻中隔变异45例(75%)，其中鼻隔偏曲45例(单向偏曲31例，双向偏曲14例)；犁骨软骨结合部畸形5例(肥大2例，脱位3例)；鼻隔刺16例。中鼻甲变异共43例(71.7%)，其中反曲15例；气化9例；双侧不对称20例(46.5%)。不对称中鼻甲中，增大一侧多见于鼻隔偏移方向的对侧，多数伴有不同程度的钩突移位和筛漏斗或鼻道狭窄。结论：鼻腔和中鼻甲不对称与鼻中隔偏曲关系密切，后者是导致前组鼻副窦引流通道中的关键部位--中鼻道和筛漏斗狭窄的重要原因。