CORRECTION OF SADDLE-SHAPED DEFORMITY OF THE NASAL DORSUM WITH AUTOLOGOUS COSTCHONDRAL GRAFT

Background. Aesthetic and functional nasal surgery is becoming more and more popular and in demand every year, due to this, the number of postoperative complications increases, as well as the high demand of patients for the quality of rhino-surgeries. The most important problem of patients who underwent primary septorhinoplasty is complications that develop in the early or late postoperative period, deficiency of bone or cartilage tissue of the nasal dorsum, vector deformation of the nasal tip. For local elimination of tissue volume deficiency of the nasal dorsum (saddle deformation), crushed or fragmented lamellar costal cartilaginous autograft is used, at the discretion of the operating surgeon and the technique they master. Free auricular cartilage autograft is also used to strengthen and stabilize the structure of the dome section of the nasal tip, as well as to stabilize and strengthen the caudal section of the nasal septum. Most of the methods of compensating for the volume deficit of the osteochondral section of the nasal dorsum after primary unsuccessful rhinoplasty or other post-traumatic deformities involve the use of an osteochondral solid-lamellar autograft, which is not always sufficient in length, thickness and height. The most effective and predictable way of correcting the tissue deficit of the nasal dorsum is a pre-prepared intraoperatively crushed osteochondral autograft isolated into a fragment of the superficial temporal fascia with fixation to the nasal dorsum to prevent its deformation and displacement. Purpose. To analyze the results of the operations performed in the postoperative period and to assess the aesthetic and functional effectiveness, stability of the osteochondral structure of the nasal dorsum, nasal septum, the frequency of possible complications after secondary septorhinoplasty, such as nasal septum perforation, early and late postoperative deformities of the nose, deviation and drooping of the tip of the nose. Materials and methods. The clinical study involved 18 patients who underwent secondary corrective septorhinoplasty in 2024 with the taking fragments of autologous costchondral graft and fragments of autologous cartilage of the auricle, their modeling, fixation and strengthening aimed at eliminating postoperative saddle back deformity, nasal breathing disfunction, Parrotbird-like nasal tip prolapse and its deviation. The clinical study involved male and female patients, their age ranged from 27 to 38 years old, who had previously undergone primary septorhinoplasty. The main motivating reason for contacting an aesthetic surgeon in all patients was complaints of severe or moderate deformation of the nasal dorsum in the form of its recession, nasal tip prolapse, and nasal breathing disorders. Results. After the secondary septorhinoplasty using an costchondral autograft, a satisfactory aesthetic and functional result after removing the nasal dorsum splint on the 15th day and removing intranasal splints from the nasal passages on the 4th-5th day, the majority of the patients, 92.7%, were satisfied with the aesthetic and functional result. During the control examination of all operated patients after 3-4 months of postoperative observation, 96.3% of patients noted full satisfaction with the aesthetic and functional result after the operation, even if secondary edema of the nasal dorsum was preserved. Conclusion. The results of secondary septorhinoplasty using a autologous chondral autograft of the nasal dorsum and nasal septum were assessed. More than 96% of the operated patients noted a positive aesthetic and functional stable result after 5 months of observation after the secondary septorhinoplasty.