Defects of the external nose
Such deformations are divided into 5 main groups:
1) occlusion of the back of the nose( saddle nose);
2) long nose;
3) Humpbacked nose;
4) combined deformations( long and humpy nose);
5) deformation of the terminal part of the nose.
In the region of the tip of the nose, there is an impression due to the divergence of the cartilage cartilage, one of which can protrude more anteriorly and is well probed. There is also an asymmetry in the size and location of the nasal apertures. Of other malformations, dermoid cysts and fistulas of the dorsum of the nose are observed. Cases of combined disorders in the development of the external nose and its cavity are not uncommon. Anomalies in the development of the nasal cavity can be conditionally divided into hypergenesis, dysgenesis, persistence and dystopia.
Hypergenesis of the of the inferior nasal concha is its excessive development, accompanied by a disturbance of nasal breathing, olfaction and other physiological functions of the nose.
Dysgenesis of is characterized by abnormal development of some morphological elements of the nasal cavity with a violation of their shape and correlation with other parts of the nasal cavity.
The persistence of is expressed in the preservation of elements that, during the intrauterine development of the child, should undergo a reverse development and at the time of birth, be absent.
The dystopia is characterized by the development of separate anatomical formations of the nasal cavity in an unusual place for them.
Violations of the structure of the organ in developmental abnormalities lead to a change in the function of not only the nose, but also of other organs, as well as the appearance of cosmetic defects. In this case, the surgeon can have different tasks: to eliminate the defect, disfiguring the face of the child, restore lost functions or solve both problems simultaneously.
Defects that disrupt the harmonic structure and do not meet the aesthetic requirements are eliminated by cosmetologists. Operations on the external nose in children are rare. Indications for surgical interventions in the nasal cavity with its anomaly are the violation of one or more functions of the nose, inflammatory diseases of the middle ear and paranasal sinuses, hearing impairment without signs of inflammation of the middle ear, chronic inflammatory diseases of the upper respiratory tract.
Contraindications( temporary) for surgery may be acute otitis media, acute inflammatory diseases of the upper respiratory tract, tonsillitis, nasal furuncle and furunculosis, infectious diseases. It is necessary to refrain from surgical interventions at the far-advanced stage of pulmonary tuberculosis, diabetes and blood diseases.
One of the operations that are performed with abnormal nasal development is submucosal resection of the inferior nasal concha. Indication for such an operation is a violation of nasal breathing and smell. Before the operation, local anesthesia is carried out with a 3-5% solution of cocaine with epinephrine and 0.5% solution of novocaine.
The operation involves four consecutive steps.
Stage I - incision of the mucous membrane of the nasal cavity.
II stage - separation of the mucosa from the bone base of the inferior nasal shell.
Stage III - removal of a part of the nasal shell( konkhotomy), which is produced with scissors or a special tool - konkhotom. The nasal concha is removed, keeping the mucous membrane.
IV stage - the laying of the previously separated mucous membrane on the wound surface.
After the operation, the nasal cavity is swabbed, which is of great importance in keeping the detached flap of the mucous membrane. The tampon is removed more often on the 2nd day after the operation. Complications after surgery usually does not happen.
Another type of operative correction of a congenital anomaly in the development of the nasal cavity is the displacement of the nasal concha to the side wall of the nasal cavity. Such an operation is performed in the case of disturbance of nasal breathing and smell. After anesthesia( anesthesia), the nasal concha( middle, lower) is diverted to the side wall of the nasal cavity. With increased stability of the nasal shell, when it is not moved away by the nose-spreader, it is broken at the attachment site and then pushed aside sideways. In a number of cases, only the curved portion of the nasal shell is sideways. In this case, it is possible not only to preserve the entire nose bowl, but also to restore its normal configuration. In this case, the natural openings of the paranasal sinuses are not blocked, and due to the release of the lumen of the nasal cavity, it is possible to restore the impaired sense of smell.
If necessary, conduct another kind of surgery - submucosal resection of the bullous middle nasal shell. Bullous changes in the nasal concha are vesicles of various forms and contents that are located on the middle nasal concha. An operation is performed in the event of a disturbance of nasal breathing and smell. The choice of the procedure of operation is determined by the state of the bull's cavity( the presence of pus, inflammation) and its size. The first variant of the operation is used for a small size bull, when it is removed entirely. The second variant of the operation is used for large bulls.
In this case, a partial removal of the bullae of the middle nasal shell is carried out. After the operation, a tamponade of the nose is produced.