目的：探讨一种在综合鼻整形中通过L形硅胶假体置入结合自体耳软骨移植新方法，以替代中隔软骨、或肋软骨移植物应用。方法：通过开放入路，松解下外侧软骨，将L形鼻假体长臂置入鼻根鼻背区鼻骨浅面、鼻软骨浅面；短臂置入前鼻中隔角前方。以松解后的下外侧软骨中间脚、内侧脚包裹L形鼻假体短臂两侧，以耳软骨移植物包裹短臂及转折部前面，并完成鼻尖区多层帽子移植。结果：本组43例综合鼻整形患者，随访其术后3～30个月，所有患者随访期间均未出现假体感染、顶出。2例患者鼻尖旋转无改善且伴鼻背部假体扭曲；3例鼻尖形态欠自然，呈“鹦鹉嘴”样改变；所有病例均未出现假体感染、露出。余患者鼻根鼻背鼻尖外观均获得改善，鼻尖形态自然。结论：在开放式鼻整形中选择特定外形的L形硅胶假体，通过鼻尖区假体置入方法的改进结合自体耳软骨移植物应用，不仅能达到鼻根鼻背外观明显改善的隆鼻效果，而且可达到替代中隔软骨或肋软骨鼻尖移植的获得的确切的鼻尖成形效果，但较重的短鼻病例不适合应用此法。%Objective To explore an technique including L-shaped silicone implantation and autologous cartilage graft in rhinoplasty without the application of autologous septal cartilage graft or autologous rib cartilage graft. Methods In the open rhinoplasty,the lower lateral cartilages were released, then the longer part of L-shaped silicone implant were placed on the surface of nasal bones and upper lateral cartilages.The shorter part were placed in front of the anterior septal angle.The medial and middle crura of lower lateral cartilages were fixed beside the shorter part of the L-shaped silicone implant,and the auricular cartilage grafts were fixed in front of the corner part and the shorter part of the L-shaped silicone implant.Then layers of the auricular cartilage cap grafts were placed. Results 43 cases were followed up for 3 to 30 months without any postoperative infection or implant extrusion.Tip rotations were not corrected effectively with dorum implant distorted shape in 2cases.Tip "parrot mouth" deformity presented in 3cases.Satisfactory and natural radix drsum and tip shape were obtained in other cases. Conclusions By improving the implantation technique in nose tip with special L-shaped silicone implant and auricular cartilage grafts. In the open rhinoplasty,Radix,dorsum augmentation and nasal tip rhinoplasty could also be effectively performed simultaneously. While, autologous septal cartilage grafts or autologous rib cartilage grafts might not be necessory. But,the technique is not suitable for the severe short nose cases.
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