摘要目的 探讨应用鼻中隔、耳软骨的鼻尖支撑结构及鼻尖细化等成形术治疗衬里不足病例的临床效果.方法 以鼻中隔延伸移植物(SEG)与鼻小柱支撑移植物(CS)构成鼻尖主要支撑结构.再根据其尺寸是否直接满足所需鼻尖位置,进一步选择支撑结构处理方法:满足时,鼻尖支撑结构末端超过鼻翼软骨最大牵拉位置,达到或接近所需鼻尖位置;不能满足时,利用耳软骨,包夹SEG进一步增高、延长鼻尖支撑结构,使支撑结构末端达到或接近所需鼻尖位置.鼻尖细化成形:支撑结构末端高于原穹窿大于或等于3 mm,利用耳软骨重塑鼻翼软骨穹窿.支撑结构末端高于原穹窿小于3 mm:于穹窿上,将多层的鼻尖盖板移植物重叠置于支撑结构两侧.结果 42例术后随访6～18个月.术中鼻尖支撑结构尺寸直接满足鼻尖位置的18例,其中13例应用耳软骨重塑穹窿,5例应用多层鼻尖盖板移植物;鼻尖支撑结构尺寸不能直接满足鼻尖位置的24例,其中14例应用多层鼻尖盖板移植物,10例应用耳软骨重塑穹窿.所有病例均取得较满意效果.结论 对于衬里不足的病例,根据术前设计、移植物尺寸,合理设计鼻尖支撑结构,再利用鼻尖盖板移植物或耳软骨重塑穹窿进行鼻尖成形,可以取得相对满意的效果.

abstractsObjective To analyze the plasty of the tip framework and the nasal tip in insufficient-lining cases with auricular and septal cartilage.Methods The tip framework was formed by using septal extension graft (SEG) and columellar strut (CS) to construct the main framework of nasal tip,and then according to the size of the graft the next processes were chosen for supporting structure.When the graft size met the tip position,the caudal margin of the framework could be beyond the maximum stretch position of the lower lateral cartilage and reached or was close to the expected tip position.When the graft size was insufficient,auricular cartilage was used to hold the caudal margin of the framework to extend or to heighten the framework further.Refined plasty of nasal tip was as follows:when the end of framework was higher than or equal to the dome above 3 mm,auricular cartilage strip was used to reconstruct the dome;when less than 3 mm,multilayer onlay grafts were used to heighten the dome.Results From May 2013 to May 2015,42 cases were followed up from 6 months to 18 months.18 cases belonged to the type 1,including 13 cases using ear cartilage to reconstruct dome,5 cases using onlay graft;24 cases belonged to the type 2,including 14 cases using onlay graft and 10 cases using ear cartilage to reconstruct the dome.They all got good results.Conclusions To the insufficient lining cases,the appropriate method can be chosen to form stable tip framework according to the preoperative design and the graft size.Then onlay grafts or dome reconstruction technique is used to form the tip.Most of the insufficient-lining cases can get satisfactory results.