Because the present methods of treatment either variable results or are given only for specific indications, I have treated a patient by different method.
In this case, correction and on the superintendent deformity was achieved by inserting a process heterogeneous bone transplant between the nasal mucous membrane lapse and maintain it in correct position by suture inserted through holes drilled in the bone.
In this way, or support to the tip of the nose was achieved by means of a strut place inside the nasal septum.
Saddle nose treatment? How to prevent?
Treatment Summary saddle nose:
Saddle nose can be filled by suitable materials rhinoplasty to achieve booster Biliang, raise the nose purposes. Simple saddle nose multi-use medical silicone rubber. The complexity of the saddle nose surgery nose transection extended method, skin, mucous membranes release prolong graft law, forehead flap correct severe saddle nose, smelly nose surgery psychosis.
Saddle nose detailed treatment:
Treatment:
Currently, the treatment of saddle nose filling materials often used in autologous bone, autologous cartilage, medical silicone rubber and ePTFE (expanded polytetrafluoroethylene, e-PTFE) and the like.
Simple saddle nose multi-use medical silicone rubber. But with flat or rounded nose saddle nose patient complexity, the choice of “L” shaped silicone rubber filled the nose could easily lead to nasal tip skin tension is too large, skin perforation, ulceration and other complications, should be careful. It suggested the use of autologous cartilage or autogenous bone graft.
It should be noted that normal nose also has high, medium and low points, the latter from the bridge of the nose to the tip of the nose performance were significantly low and flat, due to congenital dysplasia.
In addition to national requirements by saddle nose rhinoplasty, there are a considerable part of the low bridge and the bridge of the nose who still hopes to rhinoplasty to improve appearance, increase the dimension of the nose. Saddle nose with a low bridge who are absolute indications rhinoplasty, while the person is a relative indication nose rhinoplasty.
(A) simple saddle nose surgery
Suitable for simple mild to moderate saddle nose, no obvious who deviated septum.
2. Operating Highlights
(1) prosthesis positioning: draw the eyebrows to the longitudinal axis of the nose, two inner canthal brow and the midpoint of the horizontal line, two lines intersect at the upper edge of the nose prosthesis, the width of the prosthesis should be based on the patient’s nose depending on the width and face length.
(2) prosthesis selection: commonly used filling materials are medical silicone, autologous bone and cartilage, e-PTFE and so on.
(3) prosthesis preparation: depending on design requirements sculpture prosthesis. After sterilized.
(4) anesthesia: in the nose, nasal dorsum small columns and fascia injection of local anesthetic.
(5) cut: generally used nostril incision, delphinium incision like. Intranasal incision: hidden incision, no scar, less blood loss. Nasal incision: easy surgical procedures, can raise the nose skin, long-term scar is not obvious. Incision and conducive to covert operations better.
(6) separation: separation with elongated scissors to sneak through the incision along the lower end of the nasal dorsum cartilage surface, and then, with periosteal stripping the nasal bone periosteum separated form the corresponding implant cavities, in order to ensure the prosthesis is located in the dorsum of the fascia deep.
Separation range of the bridge of the nose section, down to the tip of the nose, on both sides of the prosthesis according to the width may be, should be slightly larger than the width of the prosthesis, after the soft tissue to the implant without too much tension for the degree. If it is “L” shaped implants, you need to separate the rear of the alar cartilage inside of the foot until the anterior nasal spine.
(7) The implantation of the prosthesis: After hemostasis, the sculpture good nose prosthesis into the compartment. After confirmation, the incision was sutured.
(Ii) the complexity of the saddle nose surgery
1. The extension of the nasal cross-sectional method
(1) Indications: saddle nose deformity was complete lower nasal structure.
(2) operating points
1) lower nasal reset: in the nose and the top of the nose to make curved incision nose full thickness to form an interlinked pierced nasal defect, the lower end of the nose down reset, extended nose axis.
2) repair ripped defects: bridge of the nose portion in an appropriately sized Flip subcutaneous pedicle flap, surrounded by suturing the wound edge and the nasal mucosa, the nasal lining repair defects, then to a sliding board vessels axis of rotation forehead island flap covering the nose wound, for valve area or take direct suture full thickness skin graft coverage. Or nasolabial fold at both sides of the appropriate size for each set off a flap or island flap, lined with a flip, rotate another flap repair nasal skin defects, two watt together. Nasolabial area on both sides of the wound for direct suture.
2. skin, mucous membrane graft law extended release
(1) Indications: Severe saddle nose deformity, skin and mucous membranes were intact.
(2) operating points
1) extend the nasal skin: on the nose edge and columellar do “U” shaped incision, close to the surface of the cartilage and periosteum makes extensive skin peeling, from the eyebrows on both sides to the maxillary, zygomatic, down to the upper lip , making the skin loose, move to pull the nose.
2) extension of the nasal lining: retractor incision to expose the nasal bone and cartilage, at the edge of the curved incision about 1.5cm pear-shaped hole in the periosteum, stripped down and set off periosteal flap, to the pear-shaped hole edge. The nasal bone periosteum and nasal mucosa apart and transverse incision of the septal mucosa, pear-shaped hole upper part of the nasal cavity connected. Continue along the piriform stripped down both sides of the hole, so that together with the lower part of the nose together periosteal flap downward shift, the periosteal flap covering the ripped defect, which hit the upper edge of the pear-shaped hole edge suture.
3) correction of saddle deformity: cut from the iliac bone or cartilage, carved into the “L” shaped bracket, placing the nose position, its deep surface fit closely with the nasal bone, nasal columella base arrived at the anterior nasal spine.
4) Singles plane deformity correction: in the gingival sulcus incision in the periosteum peeled pear shaped up along the sides of the hole, a gap is formed under the periosteum, the bone will be cut and pear-shaped hole Xiu consistent arc shape, planted in the piriform both sides of the hole and on the alveolar concave, with wire fixation. Close gingival sulcus incision.
3. Correction of forehead flap saddle nose, ozena
(1) Indications: Severe saddle nose, ozena patients, nasal skin intact.
(2) operating points
1) from the inner edge of the nostril nasal cartilage incision on both sides through to the dorsum and nasal tip with scissors to make widely separated, the full release contracture, the adhesion, the shift of tissue repositioning, extended nose.
2) Press the wounds left after prolonged nose size, cut on one or both sides to tackle vascular pedicled forehead island flap between the forehead, nose hit a tunnel, which will be introduced by the flap intranasal, turn inward, and the inner edge of the nasal mucosa corresponds to suture wounds. In the nasal septum at the intermediate skin flap may be cut off to the sides, and septal mucosa suture. Valve area for a little separation can be directly sutured.
Saddle nose ate? Dietary health?
Saddle nose daily care? Precautions?
Simple saddle nose surgery postoperative care: 24 ~ 48h after dressing, after 6 ~ 7d stitches.
Simple saddle nose surgery complications:
(1) infection and hematoma.
(2) rejection or prosthetic nose down cause skin ulceration exposed.
(3) nasal prosthesis deflection, loose ends Alice move.
(4) prosthetic nose reveals translucent shadow
Saddle nose is a nose deformity, nose intermediate depression, caused by nasal trauma, syphilis, tuberculosis
As rhinoplasty beauty who, the vast majority of mild and moderate saddle nose.
Saddle nose – rhinoplasty common method
Claim Organization: doctor net saddle nose topic
Foreign tissue or artificial tissue implant
The second method is to use allograft tissue implants or the use of synthetic polymer compound instead of autologous bone or cartilage tissue implant of rhinoplasty. Its material is allogeneic bone tissue, such as cutting down on childhood bid cartilage organizations. The most commonly used at home and abroad is a solid silicone rubber such polymer materials. Using these allogeneic bone or substitutes do long high nose surgery, can greatly reduce the suffering of beauty and materials readily available and inexpensive, convenient and beautiful shaping, most people do not appear rejection, and therefore welcomed by the masses. However, it is worth noting that very few people will appear after allogeneic tissue implants or silicone rubber swelling reaction even wound healing, leading to rejection, which requires surgical removal of the implant again. So for some people with allergies do rhinoplasty cosmetic surgery need to take seriously, do not easily surgery, so as not to cause pain.
Injection rhinoplasty
The third method is injection rhinoplasty. Now many places are to carry out such operations. The material is typically injected liquid silicone rubber. This method is simple, less pain, shaping also more aesthetic advantages. Coupled without surgery can achieve the purpose of beauty, so welcomed by the people. Everything has its duality, this method is all the rage after the country, there have been many problems. As will cause incomplete solidification after injection of silicone rubber, causing spherical distortion make the nose but not the United States or, worse still cause skin allergies, skin erosion, perforation, so its application is limited. Especially in the long nose, since nose less subcutaneous tissue, the skin is relatively weak, and cause a skin ulceration, scar formation, the results fall beauty without even a scar. Cause lifelong suffering. Then the liquid silicone rubber is not impossible to use it? No. Rich parts of the subcutaneous tissue, such as the jaw, forehead, etc., or a small amount of liquid injectable silicone rubber, can play to improve the imbalance in the face of the goal. But for rhinoplasty or not liquid silicone rubber as well.
Indications
Nose flat or depressed; the complexity of the merger of the external skin, nose, within the nasal mucosa, nasal defect or scar contracture, septal defect; noma were merged columella, upper lip defect.
other issues
1. Simple saddle nose showed only flat or sunken nose, nose or nose showed support still blunt and flat, nasal no more physiological dysfunction. In this regard, the aforementioned cosmetic rhinoplasty to get a good shape.
2. Complex obvious saddle nose bridge of the nose to collapse, shorten the length of the nose, upturned nose, the nose forward, nasolabial angle greater than 110 °, depressed nasal base, accompanied by cartilage, mucous membrane or skin contracture, nose and nasolabial fold deepens, often with midface l / 3 stunted and showed “butterfly face” deformity, nasal septum, nasal dysfunction. For this type of saddle nose, cosmetic rhinoplasty can not, must row saddle nose plasty, in order to receive better treatment.
3. surgical patients 18 years of age are developmental stages, facial or body without infection, nasal sebaceous little or no rosacea, no allergies, mental status need to be stabilized.
4. stitches after 5-7 days.
5. postoperative diet, avoid spicy food, such as: ginger, raw onions, raw garlic, chili, seafood and so on.
6. Each rhinoplasty postoperative swelling varying degrees, especially in the most obvious bridge of the nose section, usually 2-3 days swelling, without special treatment.
7. Patients should be 3-4 days of oral anti-inflammatory drugs, such as: amoxicillin.
8. can not do cosmetic surgery within a month.
9. The results of operations are not satisfied, it can be implanted prosthesis removed.
Saddle nose – saddle nose clinical manifestations
Claim Organization: doctor net saddle nose topic
1. nose flat or depressed; 2. the merger of the complexity of the external skin, nose, within the nasal mucosa, nasal defect or scar contracture, septal defect;
3. noma were merged columella, upper lip defect.
Saddle nose – saddle nose diagnosis is based
Claim Organization: doctor net saddle nose topic
1. Simple saddle nose Congenital born with deposit;
2. acquired trauma, infection and nasal septum surgeries;
3. nose flat or depressed;
4. nasal skin, mucous membranes, nasal septal defect or scar contracture, can also be combined columella, upper lip defect.
Saddle nose – saddle nose treatment principles
Claim Organization: doctor net saddle nose topic
1. Simple saddle nose: rhinoplasty performed. Transplanted tissue as cartilage, rib or medical silicone rubber and other tissue substitutes, autologous cartilage or rib as well.
2. The complexity of the saddle nose: scar excision and skin grafting or flap release method; graft prosthesis support inline method.
Saddle nose – saddle nose medication principle
Claim Organization: doctor net saddle nose topic
1. Under normal circumstances surgery, medication to medication box to limit the “A”, “B” main.
2. When economic conditions permit or postoperative infection “A” key drugs ineffective, medication may include medication box to limit the “A”, “B”, “C”.
Saddle nose – auxiliary examination
Claim Organization: doctor net saddle nose topic
1. Under normal circumstances, the check box to limit the project to check the “A” main;
2. complex even when deformity or surgical complications, check the project may include a check box to limit the “A”, “B”.
Saddle nose – saddle nose Evaluation
Claim Organization: doctor net saddle nose topic
1. Cure: Recovery nose straight, nose has not downward projection, nasal labial angle slightly greater than 90 °
2. Improvement: Bridge recover relatively straight, nose lips approaching 90 °.
3. Healed: low-lying bridge of the nose is not restored.
Saddle nose – repair surgery
Claim Organization: doctor net saddle nose topic
1. cut: past use of intranasal incision, skin incision on one side of the septum between the nasal columella, thus re-enter the dorsum subcutaneous tissue.
However, in addition to at least one intranasal incision in the external nasal surgery scar, there are few other advantages, when it can not be applied to raise the nose. The incision scar is actually the bottom of the nose is not significant, in disinfection or are more advantageous in terms of the surgical procedure, especially for installation of “L” shaped model is more ideal. Common nasal incision in two ways: one is from the nose down along columella incision has been made; the other is self columellar nostril along the leading edge of the front end to make a “T” shaped incision, the actual operation may need adoption.
2. Use a small pair of scissors from the incision extends into the nose peel back side edge scissors, separation of adhesions between the subcutaneous tissue and nasal dorsum, from the eyebrows to the outside on the outside of the nasal dorsum maxilla, nasal bone and subcutaneous tissue must between complete relaxation.
3. The Department of spindle model, can be placed to observe the shape of the nose to rectify the situation, first of all should pay attention to the base with the case of the saddle nose bone model of the recess is appropriate, according to the model is the tip of the nose bridge of the nose end whether it will tilt, such as basal inappropriate, model prone to cause distortions caused deformities, such as too large or substrate irregularities and can be modified; too are more interchangeable into a larger model.
4. use “L” shaped model, should the central pillar in the small compartment separate until the bottom of the columella, down through the maxillary nasal spine; as xenograft model for their own cartilage, septum mucous membranes should be separate, and then placed in the model ; in the case of soft plastic model after model can be folded into a small pillar columellar it can fold up into the nasal after release, pay attention to the model put it, although there are in the columella strut, When pressing the tip of the nose bridge of the nose model of the terminal will not be lifted, but tension should not be too large, otherwise may hinder dorsum skin blood supply, causing necrosis induced model piercing, especially plastic models causing more surgical failure, therefore, as the tension is too large The model can be removed, repair of small to absolutely no tension but far more suitable.
5. The nose shape correction has been satisfied, can be cut with a silk suture skin, nasal dorsum cover a little gauze, with dorsum bracket (available dental proofing glue or aluminum sheet) and tape, fixed nose shape is not deformed .
Saddle nose – saddle nose after repair considerations
Claim Organization: doctor net saddle nose topic
1, the initial surgery for local cold with ice, reduce postoperative swelling, the first five days after surgery, should be local heat, promote recovery.
2, rest: time to hospitalization, pay attention to rest at home after surgery.
3, within a week after the prosthesis has not been wrapped fiber membrane in an unstable phase, so be careful not to touch, squeeze, impact local.
4, after such long-term discomfort, should go to the hospital and doctor.
The alloplastic implants are being used in rinocirurgias, having the advantage of simplifying the surgery, however, still a significant bounce rate.
Homografts have advantage over autografts because it is less subject to shortening. Among the used autografts there are the septal cartilage and rib. The use of a particular type of graft and a surgical technique is linked implicitly the surgeon’s experience (7).
In the historic course, considering the bone reconstruction in the face, first performed surgical procedure aimed to repair a defect head and canine xenograft was used.
For surgical correction of the saddle nose, initially, we used tibial crest, iliac, ribs, ulna and skullcap. Regarding the use of autograft rib cartilage both its segment, bone or osteocartilaginous can be handled.