Rinoplasti Komplikasyon Yönetimi
Özet
Rinoplasti, anatomik çeşitlilikler ve cerrahi deneyim gereksinimi nedeniyle komplikasyon riski yüksek bir operasyondur. Bu komplikasyonlar; en sık görülen ve diseksiyonun doğru planda yapılmasıyla azaltılabilen kanama, septal hematom, periorbital ekimoz gibi hemorajik sorunları kapsar. Enfeksiyöz komplikasyonlar lokal enfeksiyonlardan toksik şok sendromuna kadar değişirken, intraoperatif travmatik süreçlerde ödem, mukoperikondrial flep yırtılmaları, L-strut desteğinin bozulması ve nadiren BOS rinoresi gözlenebilir. Fonksiyonel ve estetik açıdan ise internal nazal valv kollapsı, ters V deformitesi, tip projeksiyon kaybı, alar kollaps, asimetri, açık çatı ile rocker deformiteleri ve cilt nekrozu gibi yapısal sorunlar gelişebilir. Bu komplikasyonların büyük kısmı; operasyon öncesinde hastanın doğru değerlendirilmesi, uygun olgu seçimi, titiz cerrahi planlama ve doğru diseksiyon tekniklerinin kullanılmasıyla önlenebilir.
Rhinoplasty is an operation with a high risk of complications due to anatomical variations and the requirement for surgical experience. These complications include hemorrhagic issues such as bleeding, which is the most common and can be reduced by proper dissection, septal hematoma, and periorbital ecchymosis. Infectious complications range from local infections to toxic shock syndrome, while intraoperative traumatic processes may involve edema, mucoperichondrial flap tears, disruption of L-strut support, and rarely, CSF rhinorrhea. Functionally and aesthetically, structural problems such as internal nasal valve collapse, inverted-V deformity, loss of tip projection, alar collapse, asymmetry, open roof and rocker deformities, and skin necrosis can develop. Most of these complications can be prevented through accurate preoperative patient evaluation, appropriate case selection, meticulous surgical planning, and the utilization of correct dissection techniques.
Referanslar
Surowitz JB, Most SP. Complications of rhinoplasty. Facial Plast Surg Clin North Am. 2013;21(4):639–51.
Layliev J, Gupta V, Kaoutzanis C, et al. Incidence and preoperative risk factors for major complications in aesthetic rhinoplasty: analysis of 4978 patients. Aesthet Surg J 2017;37(7):757–67.
Eytan DF, Wang TD. Complications in Rhinoplasty. Clin Plast Surg. 2022 Jan;49(1):179-189. doi: 10.1016/j.cps.2021.07.009. Epub 2021 Sep 2. PMID: 34782135.
Quinn JG, Bonaparte JP, Kilty SJ. Postoperative management in the prevention of complications after septoplasty: a systematic review. Laryngoscope. 2013;123(6):1328–33.
Gryskiewicz JM, Hatef DA, Bullocks JM, et al. Problems in rhinoplasty. Clin Plast Surg. 2010;37(2):389–99.
Kim SJ, Chang DS, Choi MS, Lee HY, et al. Efficacy of nasal septal splints for preventing complications after septoplasty: A meta-analysis. Am J Otolaryngol. 2021 May-Jun;42(3):102389. doi: 10.1016/j.amjoto.2020.102389. Epub 2020 Jan 3. PMID: 33482562
Canty PA, Berkowitz RG. Hematoma and abscess of the nasal septum in children. Arch Otolaryngol Head Neck Surg 122:1373-1376, 1996.
Hull HF, Mann JM, Sands CJ, et al. Toxic shock syndrome related to nasal packing. Arch Otolaryngol 1983;109(9):624–6.
McGuire C, Nurmsoo S, Samargandi OA, et al. Role of tranexamic acid in reducing intraoperative blood loss and postoperative edema and ecchymosis in primary elective rhinoplasty: a systematic review and meta-analysis. JAMA Facial Plast Surg 2019; 21(3):191–8.
Lee JJ, Hong SD, Dhong HJ, et al. Risk factors for intraoperative saddle nose deformity in septoplasty patients. Eur Arch Otorhinolaryngol. 2019 Jul;276(7):1981-1986. doi: 10.1007/s00405-019-05411-x. Epub 2019 Apr 2. PMID: 30937560.
Hallock GG, Trier WC. Cerebrospinal fluid rhinorrhea following rhinoplasty. Plast Reconstr Surg.1983;71(1):109–13.
Samra S, Steitz JT, Hajnas N, et al. Surgical Management of Nasal Valve Collapse. Otolaryngol Clin North Am. 2018 Oct;51(5):929-944. doi: 10.1016/j.otc.2018.05.009. Epub 2018 Jul 13. PMID: 30017094.
Locketz GD, Lozada KN, Becker DG. Osteotomies-When, Why, and How? Facial Plast Surg. 2020 Feb;36(1):57-65. doi: 10.1055/s-0040-1701478. Epub 2020 Mar 19. PMID: 32191960.
Hamilton GS 3rd. Dorsal Failures: From Saddle Deformity to Pollybeak. Facial Plast Surg. 2018 Jun;34(3):261-269. doi: 10.1055/s-0038-1653990. Epub 2018 Jun 1. PMID: 29857336.
Dibelius GS, Toriumi DM. Reconstruction of Cutaneous Nasal Defects. Facial Plast Surg Clin North Am. 2017 Aug;25(3):409-426. doi: 10.1016/j.fsc.2017.03.011. Epub 2017 May 30. PMID: 28676166.
