اوﻟﯿﻦ ﻃﺒﻘﻪﺑﻨﺪي ﮐﺎرﺑﺮدي اﺳﮑﻠﺖ ﻣﯿﺎﻧﯽ ﺑﯿﻨﯽ

The First Classification of the Middle Vault Skeleton of the Nose

زﻣﯿﻨﻪ و ﻫﺪف: ﺑﯿﻤﺎران ﻣﻌﻤﻮﻻً ﺑﻌﺪ از ﺟﺮاﺣﯽﻫﺎي زﯾﺒﺎﯾﯽ ﺑﯿﻨﯽ )رﯾﻨﻮﭘﻼﺳﺘﯽ( ﺣﺘﯽ ﺑﻌﺪ از اﺻﻼح اﻧﺤﺮاف ﺑﯿﻨﯽ و ﻋﺪم ﺗﻘﺎرن آن، ﻧﺎرﺿﺎﯾﺘﯽﻫﺎي ﻣﮑﺮري دارﻧﺪ. ﻧﻮﯾﺴﻨﺪﮔﺎن ﺑﺮ اﯾﻦ ﺑﺎورﻧﺪﮐﻪ ﻋﺪم ﺗﻘﺎرن اﺳﮑﻠﺖ ﻣﯿﺎﻧﯽ ﻣﯽﺗﻮاﻧﺪ ﻣﻨﺒﻊ اﯾﻦ ﻧﺎﻫﻨﺠﺎريﻫﺎ ﺑﺎﺷﺪ. ﻣﻌﺮﻓﯽ ﯾﮏ ﻃﺒﻘﻪﺑﻨﺪي ﮐﺎرﺑﺮدي و ﻣﻌﺮﻓﯽ ﯾﮏ ﺑﺮﻧﺎﻣﻪ اﺻﻼﺣﯽ ﺑﺮاي ﻫﺮ ﻃﺒﻘﻪ ﻣﻤﮑﻦ اﺳﺖ ﺑﻪ ﺟﺮاﺣﺎن ﮐﻤﮏ ﮐﻨﺪ ﮐﻪ ﺑﯿﻨﯽﻫﺎي ﺑﺪون اﻧﺤﺮاف و ﺻﺎفﺗﺮي را اراﺋﻪ دﻫﻨﺪ. ﻣﻮاد و روش ﻫﺎ: در ﻣﺠﻤﻮع 51 ﻣﻮرد ﺑﯿﻤﺎر ﮐﺎﻧﺪﯾﺪاي رﯾﻨﻮﭘﻼﺳﺘﯽ، ﺑﻪ ﺻﻮرت ﺗﺼﺎدﻓﯽ اﻧﺘﺨﺎب ﺷﺪﻧﺪ. ﻗﺒﻞ از ﻋﻤﻞ از ﭼﻬﺮه و ﻫﻨﮕﺎم ﻋﻤﻞ از ﻏﻀﺮوف ﺟﺎﻧﺒﯽ ﻓﻮﻗﺎﻧﯽ ﻗﺒﻞ و ﺑﻌﺪ از ﺟﺪاﺳﺎزي از ﺳﭙﺘﻮم ﻓﺘﻮﮔﺮاﻓﯽ اﻧﺠﺎم ﺷﺪ. ﻏﻀﺮوفﻫﺎي ﺟﺎﻧﺒﯽ ﻓﻮﻗﺎﻧﯽ از ﻧﻈﺮ ﺷﮑﻞ، اﻧﺪازه و اﻧﺤﻨﺎي ﺑﺨﺶﻫﺎي اﻓﻘﯽ و ﻋﻤﻮدي ﻣﻮرد ﺑﺮرﺳﯽ و ﺗﺠﺰﯾﻪ و ﺗﺤﻠﯿﻞ ﻗﺮار ﮔﺮﻓﺘﻨﺪ. ﯾﺎﻓﺘﻪ ﻫﺎ: ﺑﺮرﺳﯽﻫﺎ ﻧﺸﺎن داد ﮐﻪ ﭘﻨﺞ ﺷﮑﻞ ﻣﺨﺘﻠﻒ ﯾﺎﻓﺖ ﺷﺪ، ﺑﻨﺎﺑﺮاﯾﻦ آﻧﻬﺎ را ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻣﺸﺨﺼﺎت ﺗﻮﭘﻮﮔﺮاﻓﯽ ﻫﺮ ﻏﻀﺮوف ﺑﻪ 5 ﮔﺮوه ﺗﻘﺴﯿﻢ ﮐﺮدﯾﻢ. ﻧﺘﯿﺠﻪ ﮔﯿـﺮي: اﯾﻦ ﻃﺒﻘﻪﺑﻨﺪي ﮐﺎرﺑﺮدي ﺑﻪ ﺟﺮاح ﮐﻤﮏ ﺧﻮاﻫﺪ ﮐﺮد ﮐﻪ ﺑﻪ اﺳﮑﻠﺖ ﺑﺨﺶ ﻣﯿﺎﻧﯽ ﺑﯿﻨﯽ ﺗﻮﺟﻪ ﺑﯿﺸﺘﺮي داﺷﺘﻪ ﺑﺎﺷﺪ و ﺑﺮاي اﺻﻼح ﻫﺮ ﮔﻮﻧﻪ اﻧﺤﺮاف ﺑﺮﻧﺎﻣﻪرﯾﺰي داﺷﺘﻪ ﺑﺎﺷﺪ.

Introduction & Objective: There is frequent patient complain after crooked nose rhinoplasty operations even in apparently straight noses due to remnant of nasal deviations or asymmetries. Authors believe that middle vault skeletal asymmetry can be the source of these deformities. Introducing a practical classification and addressing the corrective plan for each class may help the surgeons to produce more straight noses post-operatively. Materials & Methods: Fifty-one rhinoplasty cases were selected randomly. Pre-operative pictures of faces and intraoperative pictures of upper lateral cartilages before and after separation from septum were taken. Hundred and two upper lateral cartilages were analyzed for shape, size and curvature of horizontal and vertical sub-units. Results: Five different shapes were found so we divided them to 5 groups according to topographic characteristics of each cartilage. Conclusions: This pragmatic classification will help the surgeon to be more concern about the middle vault and will have a plan to correct each variation.