AESTHETIC AND FUNCTIONAL ASPECTS OF RHINOSEPTOPLASTY IN VARIOUS NASAL PATHOLOGIES

J. Kholmatov, M. Ikromov ^*, K. Azizov^*, A. Abdukhalilov^*, R. Murodov^*

Department of Otorhinolaryngology of the Tajik State Medical University;

*National Medical Center of the Republic of Tajikistan

The article based on ENT clinic contains results of rhinoseptoplasty aimed to restore both shape of external nose and a range of functional properties of the nasal cavity and paranasal sinuses. It is determined that in various nose deformations not only its appearance goes bad, but nasal breathing is difficult, transporting and olfactory functions deteriorate, and in disorder of ventilation function of auditory tube conductive hearing loss grows. In this regard, a joint survey with interested specialists and a treatment of patients with nose deformations can lead to good aesthetic and functional results.

Keywords: nose deformation, hypertrophic and vasomotoric rhinitis, mucociliary transport, rhinoseptoplasty, vasotomy, submucosal resection of the nasal septum.

Introduction. It is well known that aesthetic rhinoplasty covers broad range of surgical interventions aimed at restoration of both congenital and acquired deformations of external nose [2,4,5,9].

However, a physician who aims to restore a shape of external nose of a patient, during the surgical intervention is obliged to simultaneously undertake operations restoring nose functions (respiratory, olfactory, transport, etc.) [3, 6, 7, 10]. Therefore, aesthetic surgery on nose must be performed by otorhinolaryngologists who unlike physicians of other specialties (dentofacial surgeons, cosmetologists, dentists) master more sparing endonasal techniques [1,2,5,7-9].

Unfortunately, recently majority of otorhinolaryngologists actively involved into endonasal surgery ceased to perform operations aimed at elimination of external nose deformations. In these circumstances, more dentofacial surgeons became involved in aesthetic rhinoplasty who are professionally limited to only elimination of deformation of external nose. They are unable to operate to correct endonasal functions aimed at restoration of above mentioned nasal functions that are encountered in majority patients, as a result of what patients are forced to repeatedly undergo an operation by otorhinolaryngologists.

Majority of foreign countries already improved the situation. For instance, in the United States 85% of rhinoplasty is performed by otorhinolaryngologists [1,2]. They simultaneously perform intranasal operations to restore respiratory functions and correct the nose shape. Another equally important aspect of the rhinoplasty is examination of disorder of the mucociliary clearance – most important link in nonspecific protection of upper respiratory tract resulting from majority of pathologic processes in nasal cavity and paranasal sinuses (PNS).

Up-to-date morphological methods and the latest software make it possible to not only assess such an important indicator affecting condition of the mucociliary clearance system as beat frequency of ciliums, but also examine character and synchronism of movement in more details, as well as to assess degree of dequamation (extrusion) of epithelial cells in chronic process [5,6,9,10].

Experience shows that to eliminate the nose deformation and its insufficiency, a surgical intervention aimed to reduce the size of inferior nasal turbinates, is required [5,6,9,10].

There are different methods of similar interventions. However, the most widespread is a correction of external nose with submucosal vasotomy (with associated vasomotor rhinitis) and lower sparing conchotomy (with associated chronic hypertrophic rhinitis) [6,10].

Assessment of effectiveness of the surgical treatment of these nose pathologies is complicated not only from the clinical point of view. From the morhological side it makes it even more urgent and necessary to examine all structure of both external and internal nose in details. Results of the studies may serve as an objective criteria for degree of evidence and reversibility of changes in endonasal structures after rhinoplasty with adequate endonasal surgery in various pathologies of nose and paranasal sinuses [2,5,7,9].

Present paper aims to study aesthetic and functional condition of nose before and after the rinoseptoplasty in patients with deformed external nose associated with vasomotor and chronic hypertrophic rhinitis and nasal septum deviation.

Materials and methods. Over a period September to December 2010, 36 patients with various types of deformations of external and internal nose commonly associated with vasomotor and chronic hypertrophic rhinitis aged 18 to 55 years were operated in the ENT clinic under the TSMU. Among those examined 18 patients were re-operated due to iatrogenic complications arising in other clinics of the country. There were 26 men (72.3%) and 10 women (27.7%).

The patients complained of difficulty in nasal breathing and deformation of external nose. They were then screened in clinic that included ENT examination, determination of respiratory, olfactory and transport functions, functions of auditory tube, audiometry, computer tomography (CT) of the nasal cavity and side shot of nasopharynx, as well as photo, endofoto documentation and anthropometric measurements.

Results and their discussion. Through the rhinoscopy range of grave disorders have been detected in the nasal cavity and nasopharynx (hyperaemia, edema of the nasal mucous, hypertrophy of inferior nasal conchas, muco-purulent nasal, adenoid vegetation in the nasopharynx). There are some shots of endovideorhinoscopy for demonstration (Fig. l a-f and 2 a-f).

a b c

Figs 1.

d e f

a b c

a b c

a b c

Figs 2.

d e f

After a thorough examination in the hospital and patient’s familiarization with the operation’s aim a rhinoplasty followed by a single-stage submucosal resection of nasal septum, vasotomy of lower and middle turbinates and osteotomy of nasal bone were carried out by indications.

During a comprehensive ENT examination and surgical intervention on the nose and intranasal structures with adequate local and general conservative treatment generally satisfactory results were achieved. Appearance of the external nose in operated patients became of correct and proportional shape with restored respiratory, olfactory and transport functions of the nasal cavity. State of the transport function of the nasal cavity before and after the surgery is demonstrated in tables 1 and 2.

Tables 1.

The distribution of patients according to the degree of nasal mucociliary transport before surgery

The degree of muco-ciliary transport	Norma	I	II	III
The number of patients	0	2	8	26

Tables 2.

The distribution of patients according to the degree of nasal mucociliary transport after surgery

The degree of muco-ciliary transport	Norma	I	II	III
The number of patients	30	4	2	0

Data presented in the table demonstrates significant improvement of transport function of the nasal cavity after the surgery.

Thus, having performed the rhinoseptoplasty, especially on the cartilaginous section of external nose, one should remember of the need for correction of the nasal valve aimed at restoration of its normal size.

To restore nasal breathing we apply various operations on the nasal septum and turbinates held simultaneously with the rhinoplasty. This is an important condition.

Practice shows that separation of two interventions – aesthetic surgery to restore shape and function of the nose, and functional – to restore respiratory and other mentioned functions of the nose – is wrong. Both shall be performed simultaneously. We believe that having properly assessed every individual case, it is feasible to perform necessary interventions keeping to the maximum extent possible the tissue structures, architectonics of the nasal cavity and not only restore nasal patency, but to seek to restore its proper aerodynamics.

References

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SUMMARY

AESTHETIC AND FUNCTIONAL ASPECTS OF RHINOSEPTOPLASTY IN VARIOUS PATHOLOGIES OF NOSE

M. Ikromov, J. Kholmatov, M.I.Mahmudnazarov

The article based on ENT clinic contains results of rhinoseptoplasty aimed to restore both shape of external nose and a range of functional properties of the nasal cavity and paranasal sinuses. It is determined that in various nose deformations not only its appearance goes bad, but nasal breathing is difficult, transporting and olfactory functions deteriorate, and in disorder of ventilation function of auditory tube conductive hearing loss grows. In this regard, a joint survey with interested specialists and a treatment of patients with nose deformations can lead to good aesthetic and functional results.

Keywords: nose deformation, hypertrophic and vasomotoric rhinitis, mucociliary transport, rhinoseptoplasty, vasotomy, submucosal resection of the nasal septum.

Contact person: Jamol I. Kholmatov - Professor of the department of otorhinolaryngology of TSMU, 734003, Tajikistan, Dushanbe. Tel. +992 98 104 16 34 E-mail: Kholmatovji@mail.ru