Murat İĞDE, Halil İbrahim CANTER, M. Emin MAVİLİ

Konjenital Kolumella Yokluğunun Bilateral İnternal Nazal Cilt Flepleri ve Kıkırdak Grefti ile Rekonstrüksiyonu

Giriş ve Amaç: Nasal kolümellanın konjenital aplazisi oldukça nadir görülen bir anomalidir. Deformite, kolümellanın burun ucundan filtrum tabanına kadar, alar kartilajları da içerecek şekilde izole yokluğu ile karakterizedir. Nazal kolümellanın konjenital aplazisinde septum, burun ve üst dudak gibi çevre yapılar normaldir. Olgu ve Yöntem: 26 yaşında bayan hasta, solunum güçlüğü ve burun ucu projeksiyon yetersizliği şikayetleri ile kliniğimize başvurdu. Hikâyede kolümellanın doğumda yokluğu öğrenildi. Özgeçmişinde hastanın halasında da aynı patolojinin varlığı saptandı. Fizik muayenede burun ucunun superior filtral sınıra adhezyonu ve nazal dorsal çizgide septumun kaudal sınırından burun ucuna kadar uzanan şiddetli depresyon izlendi. Rekonstrüksiyon bilateral internal nazal vestibüler deri flepleri ve alar konkal kartilaj greftleri kullanılarak yapıldı. Postoperatif flep kaybı ve yara iyileşme problemi görülmedi. 6 aylık takipte ameliyatta sağlanan burun ucu projeksiyonu postoperatif dönemde de yumuşak doku kontraksiyonu veya kartilaj rezorpsiyonu gelişmeksizin korunduğu gözlendi. Sonuç: Kolumellar defektlerin rekonstrüksiyonunda kullanılabilecek sayısız teknik olmasına rağmen her birinin kendi avantaj ve dezavantajları vardır. Bu nedenle kolümellar defektlerin cerrahi tedavisi hastaya özel olmalıdır. Kolümella rekonstrüksiyonunda internal nasal vestibüler flep kullanımı flep donör alanında görülebilen nebbe olmaması ve iyi doku uyumu nedeniyle avantajlıdır.

Reconstruction of Congenital Absent Columella With Bilateral Internal Nasal Vestibular Skin Flaps and Cartilage Grafts

Background: Congenital aplasia of the nasal columella is a very rare anomaly. The deformity is characterized by the isolated absence of the columella from the nasal tip to the root of the philtrum, including the medial crura of the alar cartilages. In congenital aplasia of the nasal columella, surrounding structures such as the septum, nose, and upper lip are normal. Patient and Methods: A 26-year old female patient has been seen with complains of difficulty in breathing and aesthetically nasal tip projection insufficiency. Columella was absent at birth. She reported the presence of same pathology with her aunt in the medical history. Physical examination revealed adhesion of the nasal tip to superior philtral margin and acute depression of nasal dorsal line, extending from caudal edge of septum to nasal tip. Reconstruction was achieved by the of bilateral internal nasal vestibular skin flaps together with alar and conchal cartilage grafts. Results: Postoperative flap survival and wound healing were uneventful. Nasal tip projection obtained peroperatively was preserved without any soft tissue contraction or cartilage resorption during 6 mouth-follow-up period. Conclusions: Although there are myriad techniques available for repairing columellar defects, each of these techniques has their own advantages and disadvantages. Therefore, the treatment of columella defects should be individualized. The internal nasal vestibular flap is useful for columella reconstruction since it avoids external scarring at the flap donor site and has the advantage of good tissue match.

Keywords:

congenital absent columella, internal nasal vestibular skin flap, cartilage grafts,

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