半侧颜面萎缩鼻畸形的软骨支撑联合鼻翼沟重建：一项多中心前瞻性研究。

文献信息

中文摘要

背景： 半侧颜面萎缩中的鼻翼畸形因结构性支撑与表面标志的同时丧失而具有挑战性。现有技术通常仅解决容积不足或框架强化中的一项。本研究评估一种将自体软骨支撑与鼻翼上沟及鼻翼-面沟同期重建相结合的策略。
方法： 在这项前瞻性多中心研究中，连续纳入半侧颜面萎缩伴单侧鼻翼塌陷且沟纹变浅或消失的患者，接受标准化手术矫正（皮下松解、自体软骨移植和多点牵引缝合）。采用标准化二维照片形态计量分析和经验证的鼻阻塞症状评估量表评估结局。
结果： 在91例入组患者中，84例完成了12至36个月的随访。观察到客观鼻翼对称性显著改善，包括鼻翼基底不对称从术前8.72±0.99 mm降至术后1.12±0.49 mm（P<0.001），鼻孔宽度差异从6.22±0.87 mm降至0.74±0.38 mm（P<0.001）。在有纵向数据可用的患者中，鼻翼上沟和鼻翼-面沟形态的表观二维照片参数显示沟纹清晰度和连续性持续改善。功能结局改善，NOSE评分从术前68.4±12.6降至末次随访时17.4±7.5（P<0.001）。总体并发症发生率低，无需重大翻修手术。
结论： 这项单臂前瞻性队列提示，软骨支撑联合鼻翼沟重建对于选定的半侧颜面萎缩患者是一种可行方法，并可能提供鼻翼对称性和表面标志清晰度的持续改善。由于缺乏对照比较组，这些发现应被视为初步结果，需要进一步比较研究以确认该技术的相对有效性。
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英文摘要

BACKGROUND: Nasal alar deformity in hemifacial atrophy is challenging due to combined loss of structural support and surface landmarks. Existing techniques usually address either volumetric deficiency or framework reinforcement alone. This study evaluates a strategy integrating autologous cartilage support with simultaneous reconstruction of the supra-alar and alar-facial grooves.
METHODS: In this prospective multicenter study, consecutive patients with hemifacial atrophy and unilateral alar collapse with groove attenuation or obliteration underwent standardized surgical correction (subcutaneous release, autologous cartilage grafting, and multi-point traction suturing). Outcomes were assessed using standardized two-dimensional photographic morphometric analysis and the validated Nasal Obstruction Symptom Evaluation scale.
RESULTS: Among 91 enrolled patients, 84 completed follow-up for 12 to 36 months. Significant improvements were observed in objective alar symmetry, including reduction in alar base asymmetry from 8.72 ± 0.99 mm preoperatively to 1.12 ± 0.49 mm postoperatively (P < 0.001) and nostril width discrepancy from 6.22 ± 0.87 mm to 0.74 ± 0.38 mm (P < 0.001). Apparent two-dimensional photographic parameters of supra-alar and alar-facial groove morphology demonstrated sustained improvement in groove definition and continuity among patients with available longitudinal data. Functional outcomes improved, with NOSE scores decreasing from 68.4 ± 12.6 preoperatively to 17.4 ± 7.5 at final follow-up (P < 0.001). The overall complication rate was low, and no major revision surgery was required.
CONCLUSIONS: This single-arm prospective cohort suggests that cartilage support combined with alar groove reconstruction is a feasible approach for selected patients with hemifacial atrophy and may provide sustained improvements in alar symmetry and surface landmark definition. Because of the absence of a comparative control group, these findings should be interpreted as preliminary, and further comparative studies are required to confirm the relative effectiveness of this technique.
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