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16Central Asian Research Journal For Interdisciplinary Studies (CARJIS)
ISSN (online): 2181-2454 Volume 2 | Issue 10 |October, 2022 | SJIF: 5,965 | UIF: 7,6 | ISRA: JIF 1.947 | Google Scholar |
www.carjis.org DOI: 10.24412/2181-2454-2022-10-87-90
RECONSTRUCTIVE RHINOPLASTY METHOD WITH EXTERNAL NOSE DEFORMATION AFTER UNILATERAL PRIMARY CHEILOPLASTY
Shoxabbos Nozimjon o'g'li Salomov
Student of Andijon State medical Institute E-mail: [email protected]
Husniddin Makhmudovich Aliyev
Andijon State medical Institute, associate professor
Manzuraxon Mukhtarovna Dalimova
Andijon State medical Institute, Senior teacher
ACTUALITY
One of the complex problems in plastic surgery of the maxillofacial region and rhinology is the development of the most rational ways to restore deformities of the external nose that occur after primary cheilorhinoplasty in patients with congenital cleft lip and palate. Anatomical and cosmetic shortcomings inherent in deformities of the external nose cause not only a violation of such a vital function as breathing, but also negatively affect the appearance and psycho-emotional state of the patient. Therefore, the anatomical and aesthetic results of corrective operations should be considered not only as restoration of the anatomical shape of the external nose, but also as a means of social rehabilitation of patients with deformities of the external nose and upper lip of various origins.
Literature data indicate that modern methods of reconstructive rhinoplasty do not allow to fully restore the natural shape and function of the nose in patients with congenital cleft lip and palate after primary cheilorhinoplasty. Of the large number of operations proposed to eliminate deformities of the external nose after primary cheilorhinoplasty, only a few developed methods have stood the test of time [1,2,3,4].
PURPOSE
This thesis presents a new improved variant of rhinoplasty to eliminate the deformity of the external nose in patients with congenital cleft lip after primary cheiloplasty. From 2011 to 2021, 68 patients with deformity of the external nose after primary cheilorhinoplasty were operated using this technique. In the postoperative
Central Asian Research Journal For Interdisciplinary Studies (CARJIS)
ISSN (online): 2181-2454 Volume 2 | Issue 10 |October, 2022 | SJIF: 5,965 | UIF: 7,6 | ISRA: JIF 1.947 | Google Scholar |
www.carjis.org DOI: 10.24412/2181-2454-2022-10-87-90
period, patients were monitored and the results of the operation were compared with the initial data. 3 months after the corrective rhinoplasty surgery, anthropometric measurements of the dimensions of the external nose were performed on the control plaster model. The height of the skin part of the nasal septum on the intact and affected sides is the same. Deviations of the skin part of the septum and back of the nose from the central line are not visually determined. The angle between the base of the nose and its wings on the right and left is symmetrical.
MATERIALS AND METHODS
The development of a new method of rhinoplasty was based on the results of an anthropometric study of plaster models of the middle zone of the face (external nose and upper lip), as well as surgical techniques that allow rational use of the tissues of the external nose, while creating optimal conditions to eliminate existing anatomical and functional disorders.
When comparing the average sizes of different parts of the external nose, we revealed significant differences in size and shape between the healthy and affected sides. Thus, in patients with deformity of the external nose after primary cheilorhinoplasty, on the affected side, the level of the arch of the nostril and the tip of the nose is significantly lower compared to the healthy side. The severity of the deformity of the external nose depends on the degree of drooping of the tip of the nose. Simultaneously with the drooping of the tip and arch of the nostrils, shortening of the skin part of the nasal septum is observed on the affected side. Changes in the position of individual parts of the external nose, in turn, lead to changes in other components of the nose, i.e. flattening of the wing and expansion of the base of the nostril. When determining the lines of upcoming incisions and cutting out a triangular flap on the deformed half of the nose in patients with deformities of the tip and wing after primary cheilorhinoplasty, one should focus on the degree of drooping of the tip and apex of the nostril arch. In this case, the difference between the lowered tip and the top of the arch of the nostrils of the affected and healthy sides should correspond to the size of the base of the triangular flap being cut out on the deformed half.
From 2011 to 2021, 68 patients with deformity of the external nose after primary cheilorhinoplasty were operated using this technique.
Of these, at the age of 16-20 years - 18 people, 20-30 years old - 40 people, 31 to 40 years old - 10 people. Women - 39, men - 29. The average age of patients is 20 - 30 years.
Central Asian Research Journal For Interdisciplinary Studies (CARJIS)
ISSN (online): 2181-2454 Volume 2 | Issue 10 |October, 2022 | SJIF: 5,965 | UIF: 7,6 | ISRA: JIF 1.947 | Google Scholar |
www.carjis.org DOI: 10.24412/2181-2454-2022-10-87-90
The majority of patients (57 people) in the period from 2001 to 2008. were operated on using this method in the clinic of maxillofacial surgery of the Tashkent Medical Academy in the Republic of Uzbekistan.
In the pre- and postoperative periods, a plaster model of the external nose was cast, and the height and angle of deviation of the skin part of the nasal septum were measured using the model.
Before surgery, the height of the skin part of the nasal septum in patients on the intact side was 16.3 ± 0.05 mm, and on the affected side - 9.8 ± 0.04 mm.
In the postoperative period, patients were monitored and the results of the operation were compared with the initial data. Three months after corrective rhinoplasty, the anthropometric dimensions of the external nose were determined on a control plaster model.
The height of the skin part of the nasal septum in patients operated on according to the proposed method after surgery on the intact side was 16.3 ± 0.05 mm, and on the affected side - 16.1 ± 0.04 mm, i.e. on the intact and affected sides, the height was almost the same.
In patients operated on in the traditional way (10 people), the difference between the intact and affected sides after the operation remains and amounts to 16.3±0.05 mm on the intact side; on the affected one - 12.5±0.04 mm.
Incorrect calculation of the triangular flap and its bed on the nasal mucosa in the postoperative period may result in eversion of the nasal mucosa and their displacement to the outside. Therefore, the shape and dimensions of the triangular flap and the bed for it must exactly match each other.
CONCLUSION
Thus, the proposed variant of reconstructive rhinoplasty in terms of functional and cosmetic parameters is the method of choice for correction of secondary deformity of the external nose after cheilorhinoplasty.
REFERENCES
1. Gusan, A. O. Restorative rhinoseptoplasty. / A.O. Gusan. - St. Petersburg: Dialogue, 2020. - 192p.
2. Kozin, I. A. Aesthetic surgery of congenital clefts of the face. / I. A. Kozin. - M.: Martis, 2016 - 563 p.
3. Guide to rhinology / ed. G.Z. Piskunova - M.: Litterra, 2021. - 960 p.
Central Asian Research Journal For Interdisciplinary Studies (CARJIS)
ISSN (online): 2181-2454 Volume 2 | Issue 10 |October, 2022 | SJIF: 5,965 | UIF: 7,6 | ISRA: JIF 1.947 | Google Scholar |
www.carjis.org DOI: 10.24412/2181-2454-2022-10-87-90
4. Semenov, F. V. Plastic rhinosurgery in the otorhinolaryngological clinic / F. V. Semenov, A. Kh. Khachak // Russian rhinology.-2018. - Appendix 3. - S. 320-324.
