سپتوم صاف و بيني كج، ديدگاهي نوين

The Upper Lateral Cartilage Deformity and Deviated Nose: A New Concept

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﺭﺷﺪ ﻏﻴـﺮ ﻗﺮﻳﻨﻪ ﺑﺎﻓﺖ ﺍﺳﺘﺨـﻮﺍﻧﻲ ﺻﻮﺭﺕ ﺩﺭ ﻣﻴﺎﻥ ﺑﻴﻤـﺎﺭﺍﻧﻲ ﮐﻪ ﺗﺤﺖ ﺭﺍﻳﻨﻮﭘﻼﺳﺘﻲ ﻗﺮﺍﺭ ﻣﻲﮔﻴﺮﻧﺪ، ﺑﻪ ﻭﻓﻮﺭ ﺩﻳﺪﻩ ﻣﻲﺷﻮﺩ. ﺍﻳﻦ ﺍﺧﺘﻼﻝ ﺷﺎﻳﻊ ﺑﺮ ﺗﻤﺎﻡ ﺍﺟﺰﺍﻱ ﺻﻮﺭﺕ، ﺍﺯ ﺟﻤﻠﻪ ﻏﻀﺮﻭﻑ ﻓﻮﻗﺎﻧﻲ ﺧﺎﺭﺟﻲ ﺍﺛﺮ ﻣﻲﮔﺬﺍﺭﺩ. ﺍﻳﻦ ﺭﺷﺪ ﻧﺎﻣﺘﻘﺎﺭﻥ ﻣﻲﺗﻮﺍﻧﺪ ﻣﻮﺟﺐ ﺗﻔﺎﻭﺕ ﺩﺭ ﺿﺨﺎﻣﺖ، ﻗﻮﺍﻡ، ﺍﻧﺤﻨﺎ ﻭ ﺧﺎﺻﻴﺖ ﺍﺭﺗﺠﺎﻋﻲ ﻏﻀﺮﻭﻑﻫﺎﻱ ﻓﻮﻗﺎﻧﻲ ﺧﺎﺭﺟﻲ ﺷﻮﺩ. ﻧﺎﺩﻳﺪﻩ ﮔﺮﻓﺘﻦ ﺍﻳﻦ ﻋﺪﻡ ﺗﻘﺎﺭﻥ ﺗﺄﺛﻴﺮ ﻗﺎﺑﻞ ﺗﻮﺟﻬﻲ ﺩﺭ ﻧﺘﻴﺠﻪ ﺭﺍﻳﻨﻮﭘﻼﺳﺘﻲ ﺧﻮﺍﻫﺪ ﺩﺍﺷﺖ، ﺑﻪ ﻭﻳﮋﻩ ﺩﺭ ﺑﻴﻤﺎﺭﺍﻧﻲ ﮐﻪ ﺍﺯ ﮐﺠﻲ ﺑﻴﻨﻲ ﺭﻧﺞ ﻣﻲ ﺑﺮﻧﺪ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﭘﺮﻭﻧﺪﻩﻫﺎﻱ 89 ﺑﻴﻤﺎﺭ ﮐﻪ ﺑﻪ ﻃﻮﺭ ﭘﻴﺎﭘﻲ ﺗﻮﺳﻂ ﻳﮏ ﺟﺮﺍﺡ ﺗﺤﺖ ﺭﺍﻳﻨﻮﭘﻼﺳﺘﻲ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻪ ﺑﻮﺩﻧﺪ ﻣﻮﺭﺩ ﺑﺮﺭﺳﻲ ﻗﺮﺍﺭ ﮔﺮﻓﺖ، ﺗﺎ ﺍﺧﺘﻼﻻﺕ ﻗﺴﻤﺖ ﻣﻴ ﺎﻧﻲ ﺩﺭ ﺁﻧﻬﺎ ﻣﺸﺨﺺ ﺷﻮﺩ ﻭ ﺍﻗﺪﺍﻣﺎﺗﻲ ﮐﻪ ﺑﺮﺍﻱ ﻫﺮ ﺑﻴﻤﺎﺭ ﺑﻪ ﻃﻮﺭ ﺧﺎﺹ ﺍﻧﺠﺎﻡ ﺷﺪﻩ ﺑﻮﺩ، ﺑﺮﺭﺳﻲ ﮔﺮﺩﺩ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﺍﺯ 89 ﻣﻮﺭﺩ ﺭﺍﻳﻨﻮﭘﻼﺳﺘﻲ، ﺩﺭ 72 ﺑﻴﻤﺎﺭ ﻏﻀﺮﻭﻑ ﻓﻮﻗﺎﻧﻲ ﺧﺎﺭﺟﻲ ﻧﺎﻣﺘﻘﺎﺭﻥ ﻭﺟﻮﺩ ﺩﺍﺷﺖ. ﺣﺪﻭﺩ 30 ﺑﻴﻤﺎﺭﺍﻥ )27 ﻣﻮﺭﺩ ﺍﺯ 89 ﺑﻴﻤﺎﺭ( ﻫﻤﺮﺍﻩ ﻏﻀﺮﻭﻑ ﻓﻮﻗﺎﻧﻲ ﺧﺎﺭﺟﻲ ﻏﻴﺮ ﻗﺮﻳﻨﻪ، ﺳﭙﺘﻮﻡﻫﺎﻱ ﺻﺎﻑ ﺩﺍﺷﺘﻨﺪ، ﮐﻪ ﺗﺮﻣﻴﻢ ﮐﺠﻲ ﺑﻴﻨﻲ ﺩﺭ ﺁﻧﻬﺎ ﻋﻠﻴﺮﻏﻢ ﺻﺎﻑ ﺑﻮﺩﻥ ﺗﻴﻐﻪ ﻣﻴﺎﻧﻲ ﺑﻴﻨﻲ ﺍﻟﺰﺍﻣﻲ ﺑﻮﺩ. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﺩﺭ ﻧﻈﺮ ﺩﺍﺷﺘﻦ ﻋﺪﻡ ﺗﻘﺎﺭﻥ ﻏﻀﺮﻭﻑ ﻓﻮﻗﺎﻧﻲ ﺧﺎﺭﺟﻲ ﺩﺭ ﻳﮏ ﺑﻴﻨﻲ ﮐﺞ ﻭ ﺗﻼﺵ ﺑﺮﺍﻱ ﺍﺻﻼﺡ ﺁﻥ، ﺩﺭ ﮐﻨﺎﺭ ﺻﺎﻑ ﮐﺮﺩﻥ ﺳﭙﺘﻮﻡ، ﻧﻘﺶ ﮐﻠﻴﺪﻱ ﺩﺭ ﮐﺎﻫﺶ ﺑﻘﺎﻳﺎﻱ ﺍﻧﺤﺮﺍﻓﺎﺕ ﻗﺴﻤﺖ ﻣﻴﺎﻧﻲ ﻳﺎ ﺑﺮﻭﺯ ﻣﺠﺪﺩ ﺍﻳﻦ ﻋﺎﺭﺿﻪ ﺑﻌﺪ ﺍﺯ ﺟﺮﺍﺣﻲ ﺩﺍﺭﺩ.

Introduction & Objective: Facial skeletal growth and development could be asymmetrical between the two sides of the face. This deformity has influence on all structures, including ULC of the nose, its thickness, elasticity, and shape. Considering this anomaly in crooked nose patients and try to correct it, may have a positive effect on our surgical result. Materials & Methods: Eighty nine rhinoplasty patient’s chart were reviewed for middle vault asymmetries and surgical procedures performed for each case were reviewed. Results: Asymmetric upper lateral cartilages were observed in 81% of cases (72 cases), and 30% of total cases had straight septum with asymmetrical upper lateral cartilages (27 cases) which needed some intervention. Conclusions: The crucial point in correcting crooked nose is to keep in mind the upper lateral cartilages deformities and trying to make them more symmetrical by septal straightening. This is effective in preventing the recurrence of the problem after surgery