【 文献重点摘要 】
 

Background: Congenital, iatrogenic, and traumatic etiologies can produce a deficient nasal dorsum requiring dorsal augmentation. Traditional techniques for dorsal augmentation as onlay dorsal graft, cantilever graft, or conventional L-framework usually have less stability and produce a rigid lobule if the single unit framework extends to the tip. Because of abundant volume and relative ease of harvest and carving, the autogenous rib cartilage has been considered the graft of choice for dorsal nasal augmentation when structural support is necessary and sufficient septal cartilage is not available.

Methods: Eighteen patients with congenital, iatrogenic, and posttraumatic low nasal dorsum were reconstructed with the extended L-cartilage framework over the past 3 years with an average postoperative follow-up of 15 months. The framework was reconstructed from 3 carved cartilaginous pieces. If needed, columellar strut, spreader, and tip grafts were also provided.

Results: All the 18 patients were generally satisfied with the cosmetic and functional outcomes at around 1-year follow-up. The nasal projection and dorsal aesthetic lines were pleasing and maintained over a prolonged postoperative follow-up period. There was free natural movement of the lobular part of the nose. No major complications were encountered.

Conclusions: Consistent, reproducible results were achieved with using the extended L-framework in primary and secondary rhinoplasty and in posttraumatic dorsal nasal deformities as well. This technique has different advantages over the conventional techniques as the extended framework is more anatomical, preserves pliability of the lobule, maintains stability without any means of fixation, and offers good control of aesthetic needs.

背景：先天性、医源性和创伤性原因可导致鼻背缺损，需要背部隆起。传统的背部强化技术如嵌合背部移植、悬臂移植或传统的L支架通常稳定性较差，如果单个单元支架延伸到尖端，则会产生刚性小叶。由于自体肋软骨体积大，切取和雕刻相对容易，在需要结构支撑和缺乏足够的鼻中隔软骨的情况下，自体肋软骨被认为是隆鼻术的首选移植物。

方法：对18例先天性、医源性和外伤后低位鼻背患者，采用延长L-软骨支架修复鼻背缺损18例，术后平均随访15个月。支架由3块雕刻的软骨片重建而成。如果需要，还提供柱状支架、扩张器和尖端移植物。

结果：随访1年左右，18例患者对美容效果和功能效果总体满意。鼻部投射和背侧美观线条令人满意，并在术后较长的随访期内保持不变。鼻小叶部分有自由的自然运动。无严重并发症发生。

结论：在一期和二期鼻整形术以及外伤后的背侧鼻畸形中使用扩展的L-支架获得了一致的、可重复性的结果。这项技术与传统技术相比具有不同的优势，因为扩展的框架更具解剖学意义，保留了小叶的柔韧性，在没有任何固定手段的情况下保持了稳定性，并提供了对美学需求的良好控制。