Revizyon Rinoplasti
Özet
Revizyon rinoplasti, ilk cerrahi sonrası hastanın memnuniyetsizliği, dokuda oluşan ciddi deformiteler ve fonksiyonel sorunlar nedeniyle başvurulan, psikolojik, fizyolojik ve anatomik boyutları olan son derece hassas bir prosedürdür. Ameliyat planlanırken hastanın psikolojik durumu, beklentileri, cilt kalınlığı ve burun çevresindeki yapıların uyumu detaylıca incelenmeli; kıkırdak desteğinin durumu palpasyon ve intranazal muayeneyle eksiksiz şekilde değerlendirilmelidir. Cerrahi sırasında septal, aurikular veya kostal kartilaj gibi sağlam otolog greft kaynaklarına sıklıkla ihtiyaç duyulmakta, bazı durumlarda ise alloplastik implantlar ya da dolgular tercih edilebilmektedir. Burnun üst, orta ve alt üçte birlik bölgelerinde görülebilen açık çatı (open roof), saddle nose, supratip bölgesinde dolgunluk yaratan pollybeak, hanging kolimella, alar retraksiyon ve mandal burun (pinched nose) gibi yapısal deformitelerin tedavisi; hastanın cilt yapısı gözetilerek spreader, batten, strut gibi özelleştirilmiş kıkırdak greftleri veya özel sütür teknikleriyle gerçekleştirilir. Sonuç olarak revizyon rinoplasti, basit düzeltmelerden çok karmaşık müdahalelere kadar uzanan geniş bir skalaya sahip olduğundan, cerrahın bilgi ve tecrübesine göre doğru hasta seçimi yapması büyük önem taşımaktadır.
Revision rhinoplasty is a highly sensitive surgical procedure performed due to patient dissatisfaction, severe tissue deformities, and functional problems following the initial surgery, encompassing psychological, physiological, and anatomical dimensions. When planning the surgery, the patient's psychological state, expectations, skin thickness, and the harmony of surrounding facial structures must be analyzed in detail, and the condition of the cartilage support should be thoroughly evaluated via palpation and intranasal examination. Solid autologous graft sources such as septal, auricular, or costal cartilage are frequently required during the operation, while alloplastic implants or fillers may also be preferred in certain cases. The treatment of structural deformities that can be observed in the upper, middle, and lower thirds of the nose—such as open roof, saddle nose, pollybeak causing fullness in the supratip region, hanging columella, alar retraction, and pinched nose—is performed using customized cartilage grafts like spreader, batten, or strut grafts, or specific suturing techniques, while carefully considering the patient's skin type. In conclusion, since revision rhinoplasty has a broad spectrum ranging from simple corrections to highly complex interventions, it is of clinical importance for the surgeon to select patients based on their own knowledge and experience to avoid causing harm.
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