Chirurgia dróg oddechowych. Syndrom brachycefaliczny – cz. II

Alaplasty

The most commonly used techniques are alaplasty techniques. They consist of the excision of a wedge of the ala nasi. This wedge can be vertical, horizontal or lateral. Incisions are made with a no. 11 scalpel blade. Hemorrhage is usually brisk on incision and may impair visibility of the surgical field to some extent, but it resolves quickly when the wound is sutured. Two to 4 sutures are placed in a simple interrupted pattern, using absorbable monofilament material.

In the vertical wedge technique incisions are started at the apex of the wedge, which is positioned slightly dorsolaterally to the dorsal limit of the slit-like opening of the stenotic naris. The medial border of the wedge is parallel to the medial wall of the ala nasi The lateral border of the wedge is made at an angle (40-70°) from the medial border. The degree of postoperative opening of the naris will be grossly proportional to the angle chosen. It is important that incisions be deep enough and include a portion of the alar fold to fully relieve the obstruction and not limit the opening to the rostral part of the nostril. Care must be taken to obtain a symmetrical opening on both sides. We find that starting with the side of the surgeon’s dominant hand (e.g. right nostril for a right-handed surgeon) helps in controlling symmetry.

The horizontal wedge technique has been described with various techniques. Hobson describes a right-angle wedge technique with the tip of the wedge positioned laterally (Hobson, 1995). Harvey describes a wide wedge with a medial tip, which is little different from a wide vertical wedge (Harvey, 1982).

The lateral wedge resection technique consists of the excision of a vertical wedge of tissue from the caudolateral aspect of the external nose, at the junction between the nose and the skin. The wedge can include a portion of skin(Nelson, 1993; Monnet, 2003) or not (Aron and Crowe, 1985). The wedge is made deep enough to include a portion of the ala...

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