بررﺳﯽ ﺻﺤﺖ ﭼﺮﺧﺶ ﻏﻀﺮوفﻫﺎي ﻧﻮك ﺑﯿﻨﯽ در ﺑﯿﻤﺎران Bulbous Pinch و ﮐﺎرﺑﺮد آن

Evaluation of LLC Rotation in Bulbous Pinch Patients and its Applications

زﻣﯿﻨﻪ و ﻫﺪف: ﻃﺒﻖ ﻧﻈﺮ ﺷﯿﻦ و ﮐﻮﻧﺴﺘﺎﻧﺘﯿﻦ، دﻓﻮرﻣﯿﺘﯽ Bulbous Pinch ﺑﯿﻨﯽ، ﺑﺎ ﺗﺤﺪب ﻗﺪاﻣﯽ ﻧﻮك ﻏﻀﺮوف ﭘﺎﯾﯿﻨﯽ ﺧﺎرﺟﯽ )LLC( ﺑﻪ ﻫﻤﺮاه Pinch ﺑﻮدن ﻧﺎﺣﯿﻪ ﺧﻠﻔﯽ ﺗﻌﺮﯾﻒ ﻣﯽﺷﻮد. اﯾﻦ وارﯾﺎﺳﯿﻮن آﻧﺎﺗﻮﻣﯿﮏ ﺷﺎﻣﻞ ﭼﺮﺧﺶ رو ﺑﻪ ﺑﺎﻻ و داﺧﻞ ﯾﺎ ﺳﻔﺎﻟﯿﮏ ﮐﺮوس ﻟﺘﺮال در ﺑﯿﻤﺎران ﺑﺎ ﺑﯿﻨﯽ Bulbous ﻣﯽﺑﺎﺷﺪ. آﻧﻬﺎ ﻧﺸﺎن دادﻧﺪ در ﺑﯿﺸﺘﺮ ﻣﻮارد Bulbous Pinch، ﻏﻀﺮوف ﺑﺠﺎي اﻣﺘﺪاد در راﺳﺘﺎي ﮐﺎﻧﺘﻮس ﺧﺎرﺟﯽ، ﺑﻪ ﺳﻤﺖ ﮐﺎﻧﺘﻮس داﺧﻠﯽ ﻗﺮار ﮔﺮﻓﺘﻪ اﺳﺖ و ﺑﻪ ﻫﻤﯿﻦ دﻟﯿﻞ آن را ﻣﺎل ﭘﻮزﯾﺸﻦ ﺳﻔﺎﻟﯿﮏ ﻧﺎﻣﯿﺪﻧﺪ. ﺑﺮاﺳﺎس اﯾﻦ ﻓﺮﺿﯿﻪ، ﺟﻬﺖ اﺻﻼح اﯾﻦ دﻓﻮرﻣﯿﺘﯽ، ﺟﺎﺑﺠﺎﯾﯽ ﮐﻮدال ﻏﻀﺮوف را ﭘﯿﺸﻨﻬﺎد ﻧﻤﻮدﻧﺪ، ﮐﻪ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺷﯿﻮع اﯾﻦ ﻧﻮع ﻗﺮار LLC، اﻧﺠﺎم آن در ﺑﺴﯿﺎري از ﻣﻮارد رﯾﻨﻮﭘﻼﺳﺘﯽ اﻟﺰاﻣﯽ ﻣﯽﮔﺸﺖ. ﻫﺪف اﯾﻦ ﻣﻘﺎﻟﻪ اﻧﺪازهﮔﯿﺮي زاوﯾﮥ دﻗﯿﻖ ﮐﺮوس ِﻟﺘﺮال ﻧﺴﺒﺖ ﺑﻪ ﻧﻘﺎط ﺛﺎﺑﺖ ﻣﺮﺟﻊِ ﺻﻮرت اﺳﺖ. ﻣﻮاد و روش ﻫﺎ: در 40 ﻣﻮرد رﯾﻨﻮﭘﻼﺳﺘﯽ ﻣﺘﻮاﻟﯽ، ﺣﺪود LLC و ﺧﻄﻮط اﻓﻘﯽ و ﻋﻤﻮدي، روي ﺻﻮرت ﺑﯿﻤﺎران رﺳﻢ ﺷﺪه و ﺑﺮاﺳﺎس وﺟﻮد ﯾﺎ ﻋﺪم وﺟﻮد دﻓﻮرﻣﯿﺘﯽ Bulbous Pinch ﺑﻪ دو ﮔﺮوه ﺗﻘﺴﯿﻢ ﺷﺪﻧﺪ. زواﯾﺎي LLC ﺳﻤﺖ راﺳﺖ و ﭼﭗ ﻧﺴﺒﺖ ﺑﻪ ﺧﻄﻮط ﻓﻮق اﻧﺪازهﮔﯿﺮي ﺷﺪ و ﺟﻬﺖ ﺑﺮرﺳﯽ ِوﺟﻮد اﺧﺘﻼف ﻣﻌﻨﯽدار در دو ﮔﺮوه ﺑﺎ ﻫﻢ ﻣﻘﺎﯾﺴﻪ ﺷﺪﻧﺪ )16 SPSS(. ﯾﺎﻓﺘﻪ ﻫﺎ: ﺗﻔﺎوت ﻣﻌﻨﯽداري در ﻣﻘﺎﯾﺴﻪ ﭼﺮﺧﺶ LLC ﻧﺴﺒﺖ ﺑﻪ ﺧﻂ اﻓﻘﯽ ﯾﺎ ﻋﻤﻮدي ﺑﯿﻦ دو ﮔﺮوه وﺟﻮد ﻧﺪاﺷﺖ. ﻧﺘﯿﺠﻪ ﮔﯿـﺮي: ﺑﺮاﺳﺎس ﯾﺎﻓﺘﻪﻫﺎي ﻣﺎ، Pinch ﺷﺪن دﯾﻮاره ﻟﺘﺮال ﺑﯿﻨﯽ ﻧﻤﯽﺗﻮاﻧﺪ ﺛﺎﻧﻮي ﺑﻪ ﻣﺎل ﭘﻮزﯾﺸﻦ ﺳﻔﺎﻟﯿﮏ ﺑﺎﺷﺪ، ﺑﻠﮑﻪ ﻋﺎﻣﻞ ﺗﺤﺪب ِﺷﺪﯾﺪ ﺧﺎرﺟﯽ و ﺧﻠﻔﯽ ﮐﺮوس ﻟﺘﺮال اﺳﺖ. اﻫﻤﯿﺖ اﯾﻦ ﯾﺎﻓﺘﻪ در ﺗﻌﯿﯿﻦ روﯾﮑﺮد اﺻﻼﺣﯽ اﯾﻦ دﻓﻮرﻣﯿﺘﯽ اﺳﺖ.

Introduction & Objective: Sheen and Constantian defined Bulbous pinch deformity as anterior convexity of LLC dome with posterior depression. This variation includes upward-inward rotation of lateral crura in bulbous tip patients. According to them most of “bulbous pinch” LLCs are positioned toward medial canthus, and so they called it cephalic displacement. They recommended the caudal displacement cartilages for the majority of rhinoplasty cases whom they report as having this variation. Our goal of this study was to measure the angle of lateral crura with fixed points on the face. Materials & Methods: We marked LLC contours and vertical and horizontal lines on 40 patients’ face and divided them into two groups of bulbous pinch and none bulbous pinch groups. The right and left side angles of LLCs with the midline and horizontal line were measured and were compared to find out if there is any difference between the two groups. Results: There was no statistically significant difference between the two groups. Conclusions: We believe that the real reason behind nasal lateral wall pinching is the convexity of posterior and lateral crura. These findings give us a road plan to correct this kind of nasal tip deformities.