ﻣﻘﺎﯾﺴﻪ ﻏﯿﺮ ﻗﺮﯾﻨﮕﯽ ﺻﻮرت، ﺗﻨﻪ، ﺑﯿﻨﯽ و ﭘﻬﻨﺎي ﺑﯿﺸﺘﺮ در ﺳﻤﺖ ﭼﭗ، ﯾﺎﻓﺘﻪ ﺟﺪﯾﺪ

The Relation between Face Torso and Nose Asymmetry and their Width Dominancy on the Left Side (New Finding)

زﻣﯿﻨﻪ و ﻫﺪف: ﻏﯿﺮﻗﺮﯾﻨﮕﯽ ﯾﺎﻓﺘﻪاي ﺷﺎﯾﻊ در ﺣﯿﻮاﻧﺎت )Bilaterian( و ﺧﺼﻮﺻﺎً اﻧﺴﺎن ﻣﯽﺑﺎﺷﺪ. ﻣﺸﺎﻫﺪه و ﻣﻌﺎﯾﻨﻪ ﺑﺴﯿﺎري از ﺑﯿﻤﺎران و ﻓﺘﻮﮔﺮاﻓﯽ آﻧﻬﺎ در ﻃﯽ ﻋﻤﻞ ﺟﺮاﺣﯽ راﯾﻨﻮﭘﻼﺳﺘﯽ ﮐﻪ ﻋﻤﻠﯽ ﻣﺘﺪاول در ﻣﻨﻄﻘﻪ ﺟﻐﺮاﻓﯿﺎي ﻣﺎ ﺑﻪ ﻋﻠﺖ داﺷﺘﻦ ﺑﺰرﮔﺘﺮﯾﻦ ﺑﯿﻨﯽﻫﺎ و ﻫﺎﻣﭗ ﻧﺴﺒﺖ ﺑﻪ ﻫﺮ ﻣﮑﺎن دﯾﮕﺮي ﻣﯽﺑﺎﺷﺪ، ﻣﺎ را ﺑﻪ اﯾﻦ ﻧﺘﯿﺠﻪ رﺳﺎﻧﺪه اﺳﺖ ﮐﻪ در ﺑﺴﯿﺎري از ﺑﯿﻤﺎران ﺻﻮرت و ﺑﯿﻨﯽ در ﺳﻤﺖ ﭼﭗ ﭘﻬﻦﺗﺮ ﻣﯽﺑﺎﺷﺪ. اﯾﻦ ﻣﺸﺎﻫﺪات اﯾﻦ ﺷﮏ را ﺑﺮﻣﯽاﻧﮕﯿﺰد ﮐﻪ ﺷﺎﯾﺪ اﯾﻦ ﻗﺎﻧﻮن در ﻣﻮرد ﺗﻤﺎم ﺑﺪن ﺻﺪق ﮐﻨﺪ، ﺑﻨﺎﺑﺮاﯾﻦ ﻧﻮﯾﺴﻨﺪﮔﺎن، اﯾﻦ ﻣﻘﺎﻟﻪ را ﺑﺮاي رﺳﯿﺪن ﺑﻪ ﻧﺘﯿﺠﻪ در 3 ﻗﺴﻤﺖ ﻃﺮاﺣﯽ ﮐﺮدﻧﺪ. ﻣﻮاد و روش ﻫﺎ: روش 1 ـ ﺷﺮح ﻋﻤﻞ 50 ﺑﯿﻤﺎري ﮐﻪ ﺗﺤﺖ ﻋﻤﻞ راﯾﻨﻮﭘﻼﺳﺘﯽ ﻗﺮار ﮔﺮﻓﺘﻪ ﺑﻮدﻧﺪ، ﻣﻄﺎﻟﻌﻪ ﺷﺪ ﺗﺎ ﺳﻤﺖ ﭘﻬﻦﺗﺮ ﯾﮏ ﺳﻮم ﻓﻮﻗﺎﻧﯽ، ﻣﯿﺎﻧﯽ و ﺗﺤﺘﺎﻧﯽ ﺑﯿﻨﯽ ﻣﺸﺨﺺ ﺷﻮد. روش 2 ـ ﻋﺮض ﺻﻮرت و ﻗﻔﺴﻪ ﺳﯿﻨﻪ در 31 ﺑﯿﻤﺎر اﻧﺪازهﮔﯿﺮي ﺷﺪ ﺗﺎ ارﺗﺒﺎط ﺑﯿﻦ آﺳﯿﻤﺘﺮي ﺻﻮرت و ﺑﺪن ﻣﺸﺨﺺ ﺷﻮد. در ﻫﻤﯿﻦ ﮔﺮوه اﻧﺘﻘﺎل ﺗﺼﻮﯾﺮ ﻧﯿﻤﻪ راﺳﺖ و ﭼﭗ ﻫﺮ ﮐﺪام از ﺑﯿﻤﺎران ﺑﺮ روي ﻋﮑﺲ ﻫﺮ ﮐﺪام از ﺑﯿﻤﺎران اﻧﺠﺎم ﺷﺪ ﺗﺎ ﺗﻔﺎوت ﺳﻤﺖ راﺳﺖ و ﭼﭗ ﻣﻮرد ﺑﺮرﺳﯽ ﻗﺮار ﮔﯿﺮد. روش 3 ـ ﭼﻬﻞ و ﻫﺸﺖ ﺳﯽ ﺗﯽ اﺳﮑﻦ ﻗﻔﺴﻪ ﺳﯿﻨﻪ و ﻟﮕﻦ ﻣﺮﺑﻮط ﺑﻪ 48 ﺑﯿﻤﺎر ﻣﻮرد ﻣﻄﺎﻟﻌﻪ ﻗﺮار ﮔﺮﻓﺖ و ﻋﺮض ﻫﺮ ﻧﯿﻤﻪ ﻗﻔﺴﻪ ﺳﯿﻨﻪ و ﻟﮕﻦ اﻧﺪازهﮔﯿﺮي ﺷﺪ. ﯾﺎﻓﺘﻪ ﻫﺎ: 1- ﻋﺮض ﻗﺎﻋﺪه ﭘﺮه ﺑﯿﻨﯽ (Alar Base) در 17 ﺑﯿﻤﺎر ﺑﺮاﺑﺮ ﺑﻮد و در 5 ﺑﯿﻤﺎر )10%( ﻗﺎﻋﺪه ﭘﺮه ﺑﯿﻨﯽ (Alar Base) در ﺳﻤﺖ راﺳﺖ ﭘﻬﻦﺗﺮ ﺑﻮد ﮐﻪ اﯾﻦ آﻣﺎر در ﺧﺼﻮص ﺳﻤﺖ ﭼﭗ 28 ﺑﯿﻤﺎر P.value=0.001)(. اﺳﺘﺨﻮان ﺟﺎﻧﺒﯽ ﺑﯿﻨﯽ در 22%ﺑﯿﻤﺎران در ﺳﻤﺖ راﺳﺖ و ﭼﭗ ﺑﺮاﺑﺮ و در 78% ﻣﻮارد در ﺳﻤﺖ ﭼﭗ ﭘﻬﻦﺗﺮ ﺑﻮد 0.03=P.value(. در 11 ﻣﻮرد در ﺳﻤﺖ راﺳﺖ و در 5 ﻣﻮرد در ﺳﻤﺖ ﭼﭗ ﺟﻬﺖ ﺗﻘﻮﯾﺖ (Lower Lateral Cartilage) LLC از اﻻر اﺳﺘﺮات (Alar Strut) اﺳﺘﻔﺎده ﺷﺪ .P.value=0.001)( .ﻧﺎﺣﯿﻪ اﺳﮑﺮول Scroll Area)( در 21 ﻣﻮرد در ﺳﻤﺖ ﭼﭗ ﮐﻪ ﭘﻬﻦﺗﺮ ﺑﻮد، ﺗﺤﺖ اﺻﻼح (Trimming) ﻗﺮار ﮔﺮﻓﺖ ﮐﻪ در ﻣﻮرد ﺳﻤﺖ راﺳﺖ در ﻫﯿﭻ ﻣﻮردي ﻧﯿﺎز ﺑﻪ اﯾﻦ اﻗﺪام ﻧﺸﺪ. 2- در ﮔـﺮوه ﺗﻨـﻪ و ﺻﻮرت 64/5% از ﻣﻮارد در ﺳﻤﺖ ﭼﭗ ﭘﻬﻦﺗﺮ ﺑﻮدﻧﺪ ﮐﻪ اﻟﺒﺘﻪ اﯾﻦ ﻧﺘﯿﺠﻪ آﻣﺎري ﻣﻌﻨﯽدار ﻧﺒﻮد، 0.2, >0.05=P.value( و اﻧﺘﻘﺎل ﺗﺼﻮﯾﺮ ﭼﭗ ﺑﻪ ﭼﭗ و راﺳﺖ ﺑﻪ راﺳﺖ ﻧﯿﺰ ﻧﺸﺎندﻫﻨﺪه ﻫﻤﺴﻮ ﺑﻮدن ﭘﻬﻨﺎي ﺑﯿﺸﺘﺮ ﺻﻮرت و ﺑـﺪن در 68% ﻣﻮارد ﺑﻮد. 3 - در ﮔـﺮوه ﺳﯽ ﺗﯽ اﺳﮑـﻦ 85/35% ﺑﯿﻤﺎران ﻏﯿﺮﻗﺮﯾﻨﮕﯽ در ﻗﻔﺴﻪ ﺳﯿﻨﻪ و ﻟﮕـﻦ ﺑﻪ ﺻـﻮرت ﻫﻢ ﺟﻬﺖ دﯾـﺪه ﻣﯽﺷـﺪ ﮐﻪ 68/75% ﻣـﻮارد ﻣﺠـﺪداً ﺳﻤـﺖ ﭼـﭗ ﻋـﺮض ﺑﯿﺸﺘـﺮي ﻧﺴﺒﺖ ﺑﻪ ﺳﻤـﺖ راﺳﺖ داﺷﺖ P.value=0.0015)(. ﻧﺘﯿﺠﻪ ﮔﯿـﺮي: ﻏﯿﺮﻗﺮﯾﻨﮕﯽ ﺻﻮرت و ﺑﺪن در ﻫﻤﻪ اﻓﺮاد ﺟﺎﻣﻌﻪ ﯾﮏ ﻗﺎﻧﻮن اﺳﺖ، اﻣﺎ ارﺗﺒﺎط اﯾﻦ آﺳﯿﻤﺘﺮي ﺑﯿﻦ ﺻﻮرت، ﺑﺪن و ﻫﻤﭽﻨﯿﻦ ﻋﺮﯾﺾﺗﺮ ﺑﻮدن ﺳﻤﺖ ﭼﭗ ﯾﺎﻓﺘﻪ ﺟﺪﯾﺪي ﺑﻮد ﮐﻪ از اﻧﺪازهﮔﯿﺮيﻫﺎي ﻓﻮق ﻧﺘﯿﺠﻪﮔﯿﺮي ﺷﺪ. اﻫﻤﯿﺖ اﯾﻦ ﯾﺎﻓﺘﻪ ﻣﯽﺗﻮاﻧﺪ، اﯾﺠﺎد ﻧﮕﺮش ﺟﺪﯾﺪ در ﺟﺮاح و ﻫﻤﭽﻨﯿﻦ ﺑﯿﻤﺎر ﺟﻬﺖ ﭘﯿﺶ ﺑﯿﻨﯽ و ﺑﺮﻧﺎﻣﻪرﯾﺰي ﺑﻬﺘﺮ ﺟﻬﺖ ﺣﺼﻮل ﭘﯿﺎﻣﺪ ﺑﻬﺘﺮ اﻋﻤﺎل ﺟﺮاﺣﯽ ﻣﯽﺑﺎﺷﺪ.

Introduction & Objective: One of the most common findings in human beings and bilaterians is asymmetry including the asymmetry in internal organs and the exterior features. Observing the patients undergoing cosmetic surgeries specially Rhinoplasty which is so common in our outskirt and their pre-op images lead us to suspect that there may be a relation between the face and the torso asymetry and there might be a dominant wider side in both. This persuaded us to plan this study to closely record and analyse the asymetrical findings to achieve a clear conclusion. Materials & Methods: This study was designed in 3 parts: In the 1st part 50 primary rhinoplasty operation notes were reviewed to determine the wider side of upper, middle and lower third of the nose. In the 2nd part 31 patients were the subjects for the measurement of width of the face and torso to reveal any correlation between face and body asymmetry. Image transposition of right and left sides of the face and body photographs of this group was also done to analyze the left and right differences and finally in the 3rd part thoraco-abdominal CT Scans of forty-eight patients were precisely studied to determine the width of the hemi-thorax and hemi-pelvis of each Patient CT Scan. Results: 1. In the rhinoplasty group the width of alar base was wider on the left side (P. value=0.001). Nasal bone width was equal on both sides in 11 cases (22%), while it was wider on left side in 39 cases (78%) (P. value=0.03). To augment lower lateral cartilage (LLC), we put alar strut graft on the right side in 11 cases and 5 on the left side (P. value = 0.001). Wider scroll area was found and trimmed in 21 cases on left side and none on the right side (Fig.1-5, Tab.1). 2. In the face and torso group although 64.5% had wider left side face and torso, the result was not significant statistically, (P. value = 0.2, > 0.05) (Fig.6, Tab.2). The photograph transposition result in the above group also showed 68% wider face and body on the same side and predominantly wider on the left side, (Fig.7, Tab.3). 3. In the CT scan group, in 40 cases (85.35%) showed same side, thorax and pelvis asymmetry but wider on left side in 33 cases (68.75%) (P. value = 0.0015) (Fig. 8 & 9, tab. 4). Conclusions: Although asymetry of face and torso has already been discussed by many studies, this study could reveal the relation between different part asymertries and more interestingly the predominance of left side in width in both face and torso. This Achievement can help the patient have a more realistic view about the capabilities of his or her surgeon to produce symmetry in order to not being surprised by the outcome of the operation.