Les greffons en rhinoplastie ethnique
Nous avons vu les principes techniques de la rhinoplastie ethnique. les greffons y ont une part majeure . Cela s’explique par le fait que si le nez parait gros et épaté, il est en fait assez vide.On retrouve souvent une quasi absence des os propres du nez, cartilages faibles et peu aptes au soutien de la pointe. De plus la peau très épaisse lourde et grasse, n’est en général pas suffisamment soutenue et portée par la charpente ostéo-cartilagineuse.
Ainsi donc, l’une des 2 étapes essentielles de la rhinoplastie ethnique va consister, comme dans toute rhinoplastie d’augmentation, à insérer deux greffons.
-Un greffon du dorsum
-Un greffon columellaire
Differents greffons : cartilage en dé , os cranien, cartilage écrasé
Le greffon dorsal d’augmentation est souvent de grand volume et remonte très haut pour combler l’angle naso-frontal. Il ne présente pas de particularité spécifique. Les avis sont partagé et les techniques en constante évolution. Cartilage écrasé, cartilage en dés, inclus dans un manchon d’aponévrose, ou inclus dans de la colle de fibrine. Dans tous les cas ce greffon doit être solide, car ce n’est pas simple greffon de comblement. C’est pour cela que certains utilisent préférentiellement l’os, et dans ce cas la tendance est à l’os crânien.
Pour les greffons de cartilage, la conque d’oreille est la plus utilisée, mais certains préfèrent la cote. Dans les 2 cas. la crainte d’une cicatrice chéloïde (grosse cicatrice très évolutive et assez spécifique de la peau noire) est réelle. et doit faire préférer la voie d’abord antérieure pour l’oreille. classiquement sans chéloïde. Quant au prélèvement costal une cicatrice chéloïde à ce niveau peut s’avérer très fâcheuse lorsque vous êtes en maillot de bain…
Le greffon columellaire, lui non plus ne présente pas de grande particularité. Il doit être solide et suffisamment long.Il est prélevé en même temps que le précédent. J Hoeflin célèbre chrurgien de Los Angeles recommande de placer un » pea pod graft » qui a donc une forme de haricot vert. Ce greffon est placé, non pas entre, mais en avant des cartilages mésiaux. Il a l’avantage d’ouvrir très efficacement l’angle naos-labial fermé.
Les 2 greffons sont donc positionnés plus ou moins en L comme dans toutes les rhinoplasties d’augmentation.
A ces greffons, on rajoute parfois un greffon de Sheen pour mieux définir la pointe si celle si reste un peu ronde malgré le greffon columellaire.
Ces greffons permettent de résoudre la quasi totalité des problèmes, parfois on associe des ostéotomies latérales quand la racine est large.
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Merci bien pour cet article, bien sûr, il faut que l’opérateur soit bien choisi par rapport à la chirurgie désirée et l’indication bien posée pour avoir le résultat espéré.
Dr Alain Bouaziz
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Je me suis fait casser les os propre avec impossibilité de respirer il y a 4 ans lors d’une agression.
Suite à cela j’ai subi une opération en urgence, une semaine après et une autre a visée esthétique car mon nez était toujours plus aplatie qu’avant en 2015 où j’ai subi un resserrement des os propres du nez dont ostéotomie et grattage pour un défaut de projection de mon nez de profil, qui en plus me crée une légère gene repiratoire .J’ai consulté un orl qui m’a dit que j’ai une légère déviationon nasal et une petite cheloide à l’intérieur du nez la ou se situait les fils du à l’opération précedente
Je suis africain et mon nez est très large, plat avec ailes du nez et base des ailes large et peau épaisse, je n’ai pas vu de gros résultat mon chirurgien maxilo faciale de l’hôpital pitié salpêtrière veut me faire un prélèvement des os du crane pour faire une greffe sur l’arrête qui m’affinera le nez de face .
Ma volonté est d’avoir un nez moins gros et aplatie de face et plus défini
en gros par ordre de preference
1) avoir une pointe du nez moins aplatie et mieux définie
2)avoir un nez moins large
3) avoir des narines moins épatées.
Le chirugien veut faire l’opération en 3 temps, la première c’etait le resserement des os propre, la suivante c’est une greffe de l’os du crane sur l’arrête et enfin plus tard, coupé les narines car si on fait tout à la fois je peux perdre mon nez.
Ma question est la suivante pensez vous que me faire une greffe de l’os de crane sur le nez peu améliorer l’image de face.
Et vu que je fait des chéloïdes, une sur le torse il y a 17 ans et une petite à l’intérieur de l’oreille. Quelle est mon risque de faire une cheloide avec une greffe prélevé de l’os du crane ? Quelle sera la taille de la cicatrice sachant que toute ma famille a la calvitie et je sent déjà que je suis un peu dégarni devant sera t’elle visible ?
J’ai cru comprendre en lisant internet que j’aurais une dépression sur le crane , est-ce désagréable ?
Dr Alain Bouaziz
bonsoir , cela me semble très long une intervention en 3 temps. En général on met la greffe en même temps que l’on pratique les ostéotomies mais chacun a ses technique et peut être préfère-t-il poser sa greffe osseuse sur un sous sol stabilisé. Le problème de l’os du crane sur peau noir et cheveux crépus, c est que cela fait une cicatrice souvent visible . Indépendamment du risque de chéloide. Quand aux narines, le faire dans un 2ème temps est tout a fait envisageable . Si vous le desirez vous pouvez m’ envoyer des photos.
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