修正性鼻整形術

Revision Rhinoplasty

目的：修正性鼻整形術是顏面重建手術中最具挑戰性手術之一，因先前的手術增加了手術的困難度，必須要能正確診斷需矯治的變形，重建鼻內部支撐結構及外覆皮膚軟組織。材料及方法：收集自2001年10月至2005年2月間，在北部某醫學中心施行修正性鼻整形手術案例，共有27名，其中男性24名，女性3名，平均年齡27歲（介於20~56歲），含病患的性別、年齡、病因、過去曾接受過的治療及手術。手術原因為病患自覺未達理想鼻形 (n=16)及人工異體填充物或自體移植物的併發症(n=11)。主要手術步驟手術路徑皆採鼻小柱中間倒V字形及兩側邊緣切口之開放式路徑，包括採用耳殼軟骨、鼻中隔軟骨及肋軟骨等自體軟骨移植物 (n=18)，採用新的人工異體填充物 (n=4)，及僅以開放式路徑行切骨術，將之前的鼻部軟骨及移植物做相關的調整或移除 (n=5)。結果：術後併發鼻中隔血腫及耳殼血腫各有1名，均皆接受清創引流手術治癒。追蹤迄今，除2名對外觀改善不滿外，整體滿意度高達93% (25/27)，無殘留鼻塞等功能性的問題。討論：修正性鼻整形術因手術中解剖構造不清及疤痕組織，較初次的鼻整形術困難。術前需取得病人及醫師雙方對治療方法的共識，手術以有較佳的視野的開放式路徑，可提高成功率。

Background: Revision rhinoplasty is a challenge for facial reconstructive surgery. Previous surgery makes revision more difficult. The procedure requires detailed preoperative evaluation and planning to correct the key deformity and reconstruct the internal support, external soft tissue, or skin of the nose. Methods: Between October 2001 and February 2005, 27 patients (24 males and 3 females) who underwent revision rhinoplasty were enrolled at a medical center in North Taiwan. Their ages ranged from 20 to 56 years with a mean age of 27.. An unsatisfactory result (n=16) or problems with an artificial or autogenous graft (n=11) were the reasons patients sought revision. Major revision procedures were performed in an open approach. These included harvest of autogenous cartilage grafts (n=18), replacement with new artificial grafts (n=4), and osteotomy with modification of previous grafting (n=5). Results: There were 2 cases of post-revision complications (nasal hematoma and auricular hematoma) which responded to adequate incision & drainage. To date, there have been no residual functional complications although 2 patients were displeased with the results so that the rate of satisfaction was 93% (25/27). Conclusions: Revision rhinoplasty is more difficult than primary rhinoplasty because of the altered anatomy and scar tissue. Surgeon and patient must agree on the goal pre-operatively. A better operative field can be achieved in an open approach, and this contributes to a successful outcome.