Rinoplastide Orta Çatıya Yaklaşım
Özet
Rinoplastide nazal orta çatı yönetimi, fonksiyonel ve estetik başarı için kritik bir öneme sahiptir ve bu bölgedeki yetersiz müdahaleler nazal obstrüksiyon, ters V ile saddle nose deformiteleri gibi sorunlara yol açabilmektedir. Primer rinoplastide orta çatı rekonstrüksiyonunun temel endikasyonları arasında dar, deviye veya asimetrik orta çatı ile dorsal hump rezeksiyonu yer alırken; Zon 1 lateral duvar yetmezliği rölatif bir endikasyon olarak kabul edilir. Bu kapsamda cerrahlar, hava yolu fonksiyonlarını korumak ve estetik hatları restore etmek amacıyla literatürde tanımlanmış pek çok başarılı cerrahi tekniğe başvurmaktadır. Bunların arasında altın standart olarak kabul edilen ve internal valv obstrüksiyonu riskini azaltan klasik spreader greftlerin yanı sıra, hastanın kendi üst lateral kartilajının katlanmasıyla uygulanan otospreader greftler ve saddle nose deformiteleri için geliştirilen dorsal onlay spreader greftler sıklıkla tercih edilmektedir. Ayrıca internal ve eksternal nazal valv kollapsını engellemek amacıyla lateral krural strut, butterfly ve alar batten greftleri gibi otolog kıkırdak desteklerinden faydalanılmaktadır. Cerrahi greft uygulamalarına alternatif veya destekleyici olarak, daha az invaziv bir yaklaşım sunan radyofrekans ablasyon, kemiğe implante sütür (BAST), asimetriyi düzelten clocking sütürü ve ciddi deviasyonlarda uygulanan ekstrakorporeal septoplasti gibi modern yöntemler de fonksiyonel ve estetik sonuçları optimize etmek amacıyla başarıyla kullanılmaktadır.
In rhinoplasty, management of the nasal middle vault is critical for functional and aesthetic success, and inadequate interventions in this region can lead to problems such as nasal obstruction, reverse V, and saddle nose deformities. While the main indications for middle vault reconstruction in primary rhinoplasty include a narrow, deviated, or asymmetric middle vault and dorsal hump resection, Zone 1 lateral wall insufficiency is considered a relative indication. In this context, surgeons utilize many successful surgical techniques defined in the literature to preserve airway functions and restore aesthetic lines. Among these, classic spreader grafts, which are accepted as the gold standard and reduce the risk of internal valve obstruction, as well as autospreader grafts applied by folding the patient's own upper lateral cartilage and dorsal onlay spreader grafts developed for saddle nose deformities are frequently preferred. In addition, autologous cartilage supports such as lateral crural strut, butterfly, and alar batten grafts are utilized to prevent internal and external nasal valve collapse. As an alternative or support to surgical graft applications, modern methods offering a less invasive approach such as radiofrequency ablation, bone-anchored suture (BAST), clocking suture correcting asymmetry, and extracorporeal septoplasty applied in severe deviations are also successfully used to optimize functional and aesthetic outcomes.
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