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

Acquired defects and deformations of the nose can occur as a result of trauma, inflammatory diseases (furunculosis, lupus) and tumor removal. They can be divided into three main groups (F. M. Khitrov, 1954):

Group I - defects of nasal tissue:

• defects of the entire nose, i.e. total:
• unilateral defects of the bone and cartilage parts of the nose:
• subtotal defects of the nose, i.e. 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 while preserving its bones;
• partial defect of the cartilaginous part of the nose;
• defects of the bone section with preservation of the cartilage section;
• combinations of the listed defects.

Group II - deformities of the nose caused by damage to the edges of the piriform aperture, i.e. the bony base of the external nose:

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

  The side is sunken, drawn into the nasal cavity by scars).

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

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Treatment of defects and deformations of the nose

Elimination of total and subtotal defects of the nose

Method of F. M. Khitrov

FM Khitrov's method consists of the following stages:

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

The final stage 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 surgery on the face, the suture lines (8-10 days after the surgery) are irradiated with Butsky rays (dose - 1000-2000 R). This is especially indicated in cases where patients have a hypertrophic scar somewhere on the body (after surgery or other trauma).

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

If, despite irradiation, signs of keloid development appear (thickening of the scar, itching, tingling), irradiation should be repeated after 1-1.5 months.

According to available data, keloid scars occur more frequently in women after surgeries performed during menstruation or in the days immediately before or after it.

Elimination of partial nasal defects

Method of K. P. Suslov - G. V. Kruchinsky

To eliminate partial defects of the nose, local tissues (pedunculated flap from the cheek), Filatov stem (from the shoulder), helix of the auricle, mucous membrane of the upper lip, skin of the upper lip, and ectoprostheses can be used.

When transplanting a part of the auricle helix according to K. P. Suslov, it is necessary to observe the following very important rules:

1. do not injure the transplant with tweezers;
2. ensure complete contact of all layers of the transplant with the edges of the nasal defect;
3. Place the sutures at a distance of 4-5 mm from each other and do not tighten them too tightly, as this may lead to disruption of microcirculation in the transplant and its necrosis.

To increase the reliability of the transplant's engraftment, it is possible to perform the transplant on the Filatov stem. This operation is multi-stage, but it is quite justified if there is a defect not only in the wing, but also in the tip and septum of the nose.

In case of a nasal defect, it is also possible to use the modification of K. P. Suslov-G. V. Kruchinsky, which consists of the following. An endonasal lining is formed along the edge of the nasal defect by turning the skin or scar tissue into the nasal cavity. The lining should be absent only in a narrow space (3-4 mm) in the area of the edge of the ala of the nose. A defect template is cut out of gauze and applied to the stalk of the helix of the auricle in such a way that the section of the template corresponding to the through defect along the edge of the ala of the nose, taking into account its concavity, coincides with the lower free edge of the ascending part of the helix and the stalk. The rest of the template is placed on the skin in front of the auricle above the tragus.

Using a strong solution of potassium permanganate (a thin cotton swab or pen), outline the shape of the skin-cartilage transplant.

They begin to cut out the graft from the side of the concavity of the helix: with an arcuate incision, they cut the skin of the inner surface of the auricle and the cartilage, without cutting the skin of the outer surface, and then they cut it along the marked line. As a result, one section of the graft contains a strip of cartilage, covered with skin on both sides.

The size of the cartilaginous part of the transplant should be much larger than the length of the through defect (by 4-5 mm), while the size and shape of the skin part of the transplant should correspond to the size and shape of the wound.

Next, the graft is adjusted to the edges of the defect; for this, small subcutaneous tunnels up to 0.5 cm deep are made at the base of the ala of the nose and on the septum, where the ends of the cartilage will be placed. The thicker end of the cartilage, taken from the crus of the helix, is placed in a pocket on the septum of the nose, and therefore the graft should always be taken from the auricle on the side of the defect.

The ends of the cartilage are fixed with two mattress sutures (hair), bringing them out through the skin, and then the remaining sutures are applied. Such plastic surgery does not require additional corrections.

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

Correction of the recessed nasal wing

If the sinking of the wing of the nose is caused by a significant underdevelopment or traumatic defect of the edge of the pyriform aperture, it is necessary to first eliminate this by grafting auto- or allocartilage. Having created a foundation from this material, it is then possible to radically correct the shape of the wing of the nose.