Defects and deformities of the nose: causes, symptoms, diagnosis, treatment

Acquired defects and deformities of the nose can occur as a result of trauma, inflammatory diseases (furunculosis, lupus) and removal of tumors. They can be divided into three main groups (FM Hitrov, 1954):

I group - nasal tissue defects:

• defects of the whole nose, ie total:
• unilateral defects of the osseous and cartilaginous parts of the nose:
• subtotal nasal defects, ie, complete detachments of the bone and most of the cartilaginous parts of the nose (or vice versa);
• complete defects of the cartilaginous part of the nose with the preservation of its bones;
• partial defect of the cartilaginous part of the nose;
• defects of the osseous part with preservation of the cartilaginous;
• combination of the listed defects.

II group - deformities of the nose caused by damage to the edges of the pear-shaped aperture, i.e. The osseous base of the external nose:

• deformation due to destruction of the entire root of the external nose (the edges of the pear-shaped aperture and the bone-membranous septum), as a result of which the outer nose looks flattened or drawn into the nasal cavity;
• deformation resulting from the destruction of the upper part of the osseous bone base (its back is sunken, and the cartilaginous part is pulled up by scars up and back);
• deformation due to destruction of the lower part of the bone base of the nose (the dorsum of the nose looks normal, but the cartilaginous part is pulled into the nasal cavity);
• deformation caused by unilateral destruction of the osseous bone base (one
  
  side sunken, drawn into the nasal cavity by scars).

III group - combined defects of the external nose, the edges of the pear-shaped aperture and the adjacent parts of the face (cheeks and lips).

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Treatment of defects and deformities of the nose

Elimination of total and subtotal nasal defects

The method of FM Khitrova

The method of FM Khitrov consists of the following stages:

1. the formation of a round stem (on the anterior-lateral surface of the trunk) from a skin band measuring 10x24 cm;
2. transplantation of the distal end of the stem to the wrist or lower part of the forearm (after 14-16 days);
3. transplantation of the second end of the stem to the edge of the nose defect (after 14-16 days);
4. one-stage formation of all parts of the nose (after 18-21 days).

The final moment of total and subtotal rhinoplasty is the implantation of a cartilaginous or plastic base - the framework of the created nose.

To prevent the development of keloids after plastic surgeries on the face, the lines of suturing (8-10 days after the operation) are irradiated with Butsky beams (a dose of 1000-2000 R). This is especially indicated in cases where patients anywhere on the body have a hypertrophic scar (after surgery or other trauma).

After 5-10 days after irradiation, a skin reaction (pruritus, tingling, flushing) may occur, which disappears after a few days without a trace.

If, despite the irradiation, there are signs of keloid development (rumen thickening, itching, tingling), it is necessary to repeat the irradiation after 1-1.5 months.

According to reports, in women after operations performed during menstruation or in the coming days before or after it, keloid scars occur more often.

Elimination of partial nose defects

The method of K. P. Suslov-G. V.Kruchinsky

To eliminate partial defects of the nose, local tissues (flap on the cheek from the cheek), Filatov's stem (from the shoulder), the curl of the ear canal, the mucosa of the upper lip, the skin of the upper lip, and the ectoprosthesis can be used.

When transplanting a part of the curl of the auricle according to KP Suslov, the following very important rules must be observed:

1. Do not injure the graft with tweezers;
2. Ensure full contact of all layers of the transplant with the edges of the nose defect;
3. apply seams at a distance of 4-5 mm from each other and do not tighten them tight, as this can lead to a violation of microcirculation in the transplant and its necrosis.

To improve the reliability of transplant engraftment, a transplant can also be performed on the stem of Filatov's stem. Such an operation is multi-stage, but it justifies itself in the presence of a defect not only of the wing, but also of the tip and septum of the nose.

With a nose defect, a modification of KP Suslov-G can also be used. V. Kruchinsky, which is as follows. On the edge of the defect of the nose form the endonasal lining, turning the skin or scar tissue into the nasal cavity. Lining should be absent only in a narrow space (3-4 mm) in the region of the edge of the wing of the nose. A defect pattern is cut out of the gauze and a pinch of the ear pin is applied to the leg so that the patch portion corresponding to the through defect along the edge of the nose wing, taking into account its concavity, coincides with the lower free edge of the ascending part of the curl and the leg. The rest of the template is placed on the skin in front of the auricle above the tragus.

A strong solution of potassium permanganate (thin cotton wool flag or feather) is indicated by the shape of the cartilage-cartilaginous graft.

Begin to cut out the graft from the concavity of the curl: the skin of the inner surface of the auricle and cartilage is dissected by an arcuate incision, not cutting the skin of the outer surface, and then cutting it along the intended line. As a result, one section of the transplant contains a strip of cartilage, both sides covered with skin.

The dimensions of the cartilage part of the transplant should be much greater than the extent of the through defect (by 4-5 mm), while the size and shape of the skin part of the graft should correspond to the size and shape of the wound.

Further, the graft is put on the edges of the defect; for this, at the base of the wing of the nose and on the septum, small subcutaneous tunnels with a depth of 0.5 cm are made, where the ends of the cartilage will interfere. The thicker end of the cartilage, taken from the leg of the curl, is placed in the pocket on the septum of the nose, and therefore the transplant should always be taken from the auricle on the side of the defect.

The ends of the cartilage are fixed by two mattress sutures (hair), removing them through the skin, and then applying the remaining seams. Such plastic does not require additional corrections.

A.M Nikandrov (1989) uses a tissue from the auricle or a stem from the shoulder to eliminate a partial or complete nasal defect, less often from the neck; with a tip defect, the upper part of the septum of the nose and its wing - the stem from the shoulder and the graft from the auricle, and in the absence of the tip of the nose, most of the septum and the nose of the nose - the stem from the shoulder, sometimes in combination with local tissues.

Elimination of nasal contusion of the nose

If the wings of the wing of the nose are caused by a significant underdevelopment or traumatic defect in the edge of the pear-shaped aperture, it is necessary first to eliminate it by replanting the auto- or allochondria. Having created a foundation from this material, you can then radically correct the shape of the wing of the nose.