The dissertation is devoted to solving the problem of treating patients with deformities of the external nose who are planned to receive autografts in order to improve the aesthetic and functional components of the nose, improve the effectiveness of surgical treatment of patients with reconstructive rhinoplasty by identifying the factors that determine the optimal resorption of the rib graft, developing an innovative diagnostic algorithm and introducing improved methods of therapy.
Rhinoplasty is one of the ‘five most popular plastic surgeries’ in the world. According to ISAPS (2022), ‘about 1.5 million rhinoplasties’ (cosmetic and reconstructive) are performed annually. Growing demand for ‘revision rhinoplasty’ (10-15% of all operations due to unsatisfactory results of the first procedure). According to ISAPS (2022), ‘more than 300 thousand rhinoplasties are performed annually in Europe’. According to the Association of Plastic Surgeons of Ukraine, according to ISAPS members (2022), ‘5-8 thousand rhinoplasties are performed annually.’ After 2022, the number of operations decreased due to the war, but medical tourism is gradually recovering.
Complication rate: 5-15% (depending on the technique, surgeon's experience, and patient anatomy). Difficult cases: revision rhinoplasty has complications in 20-30% of cases.
Rhinoplasty remains a ‘technically challenging operation’ where the surgeon's qualifications play a key role. The industry is developing in Ukraine, but the lack of centralised statistics makes analysis difficult [55].
Incorrectly performed surgery can disrupt the function of the nasal passages, sinuses or sinus ventilation. Damage to the mucosa during surgery increases the risk of infections or chronic inflammation. Studies show that ‘3-10% of patients’ after rhinoplasty experience complications related to sinusitis, especially in revision surgery or inexperienced surgeons. Correction of anatomical defects (e.g., deviated septum, turbinate hypertrophy) improves sinus drainage and ventilation, which can ‘reduce symptoms of chronic rhinosinusitis (CRS)’ [56].
Diagnostic criteria for predicting possible negative consequences in reconstructive rhinoplasty are CT diagnostics, MRI and ultrasound [25, 82, 92]. A CT scan of the sinuses and endoscopy are mandatory to detect hidden inflammation, polyps, or anatomical abnormalities. Correction of a deviated septum together with rhinoplasty reduces sinusitis recurrence by 40-60%. When combined with septoplasty or FESS, rhinoplasty can be part of the treatment of chronic sinusitis [56].
Rhinoplasty is widely recognised as one of the most complex procedures in facial surgery, but it ranks third in popularity after eyelid (blepharoplasty) and breast (mammoplasty) surgery. Grafts are widely used in reconstructive rhinoplasty. This includes both materials of non-biological origin - implants (silicone, titanium, carbon structures, etc.) and materials of biological origin (xeno- or heterografts), as well as human origin (allografts or autografts). The greatest preference is given to grafts of human origin. Allomaterials for implantation are mainly represented by bone or cartilage tissue obtained from cadaveric material [31]. However, autografts are the most preferred - nasal septum, ear, rib cartilage. The basis of reconstructive rhinoplasty is the creation of a stable nasal framework, which will be the basis for the formation of a proportional external picture. It is also necessary to highlight the main problems of nasal reconstruction: the unreliability of the graft used, the tendency to resorption, the risk of infection, haematomas, and trophic disorders.
