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Burun Estetiği

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Burun ameliyatlarında burnu 4 temel bölüme ayırabiliriz.
1. Burun ara bölmesi kartilajı –septum kıkırdağı
2. Burun 1/3 alt bölüm, burun ucu kıkırdak ve mukozadan oluşan bölüm, alt lateral kıkırdaklar
3. Burun 1/3 orta bölüm, üst lateral kıkırdaklar
4. Burun 1/3 üst bölümü, burun kemiği, nasal bone.
Burun ameliyatlarında teknoloji;
Teknolojik gelişmeler her alanda olduğu gibi burun estetik operasyonlarında da kullanılmaktadır.
Güncel Teknolojik cihazlar burun estetik ameliyatlarında yaşanılan/yaşanabilecek bir çok sorunun üstesinden gelmede yardımcı olmayı hedefler.
Burun ara bölmesi ameliyatlarında görüşü arttırmak için kullanılan Endoskopik görüntüleme sistemleri
Burun kemiği şekillendirmesinde kullanılan Ultrasonik cihazlarla (piezoelektrik )kesme yöntemi ve yine burun 1/3 üst bölmesinde kullanılan mikrotur cihazları ( elmas –diamont keski cihazları)
Endoskop
Günümüzde sıklıkla KBB hekimlerinin kullandığı ve cerrahın görüş alanını arttıran ve ulaşılması güç noktaların görüntülenmesi, kayıt altına alınması ve bu noktalarda işlem yapılabilmesini sağlar. Tıp da bir çok yeni geliştirilen teknolojinin temel dayanağı endoskoplardır. Robotik cerrahi de bile endoskopik görüntülemenin kullanılması buna örnektir.
Burun septum bölmesinin görülemeyen, ulaşılamayan bölgeleri endoskoplarla görüntülenir. Endoskoplar burun fonksiyonel ameliyatları; konka (burun eti), polip (burun eti), sinüs – sinüzit, göz yaşı kesesi, göz – göz siniri ve nazofarenks (geniz) ameliyatları gibi burun içi bir çok ameliyatta yardımcı cihazlardır. Kapalı burun estetiği ya da açık burun estetiği ameliyatlarında görüş arttırmak amaçlı kullanılır.
Tur – Mikrotur cihazları
Ucu değişebilen ve ileri – geri, dairesel sağa sola dönüş yaparak aynı zamanda suction – aspirasyon ile sahayı temizleyebilen motorlu cihazlardır. Keski özellikleri ile kontrollü bir kesi yaparlar ve uçlarının farklılıkları ile değişen yapılardaki vücut kısımlarına ulaşılarak istenen sonuçlar alınır. Uçlarının keskinlik ve materyal yapısal özelliklerine göre titanyum elmas vb isimler alır.
Bu cihazlar burun estetik cerrahisinde 1/3 üst bölümde yani burun kemik kısmında kullanılır.
Burun kemik kısmı istenmeyen çıkıntıları, şekil bozuklukları bu cihazlarla düzeltilebilir.
Ultrasonik kesme – Piezoelektrik Cihazı
Piezocerrahi cihazları ile üzerine mekanik basınç uygulanan seramiğin genişleyip daralarak oluşturduğu ultrasonik titreşim kullanılarak kemik gibi mineralize, sert dokularda kesici etki sağlanırken mukoza, damar, sinir gibi yumuşak dokularda herhangi bir hasar oluşmaması bu teknolojinin en önemli özelliği olarak ön plana çıkmaktadır.

Ana ünite, el aparatı ve aktif kesici uçtan oluşan piezoelektirik cihazların çalışması sırasında fonksiyon gören aktif kesici uçlar yukarı – aşağı yönde 40 – 200 ve ileri – geri yönde 20 – 60 mikron arasında titreşim göstermekte ve kesici etkinin oluşması için aynı amaçla kullanılan mekanik aletlere göre çok daha az bir baskı uygulanması yeterli olmaktadır
Piezo elektrik cihazı içinde basınç artımı ile genişleyerek daralan bir seramik parça vardır ve bu genişleme – daralma ultrasonik bir titreşim oluşturur. Titreşimler yukarı – aşağı 40 – 200 ve ileri- geri 20 – 60 mikrondur.
Ultrasonik dalgaların kırma özelliğinden faydalanarak burun 1/3 üst bölümünün yani burun kemik yapısının şekillendirilmesinde kullanılır (burun törpüleme, keserek kırma vb). Burunda çekiç, guj, osteotom ve törpülerle yapılan işlemler bu cihazla yapılabilir. Kontrollü olarak kesilmesi veya törpülenmesi istenilen kısımlara şekil verme kolaylığı sağlar ve mukozal hasarı en aza indirip ameliyat süresini kısaltmayı amaçlar.
Kemik üzerine olan kesici etkinin hemen kemik altında yer alan mukoza, damar ve sinir gibi yumuşak dokular üzerine etkisi yoktur. Örneğin bir yumurtanın kabuğunu keserken hemen altında bulunan yumurta akına hiçbir kesici-delici olumsuz etkisi olmamaktadır. Bu sayede burun ameliyatları sonrası burunda şişkinlik ve morlukları azaltabileceği öne sürülmektedir.
Piezo elektrik cerrahisi 10 yılı aşkın bir süredir yaygın olarak kullanılmaktadır. İlk olarak diş hekimliği ve çene cerrahisinde (2001) kullanılan bu cihazlar son 2-3 yıldır ülkemizde burun estetik ameliyatlarında sıkça kullanılmaktadır.
Bütün bu teknolojiler burun ameliyatlarına bir çok katkı sağlamıştır ama unutulmamalıdır ki bugün çok ileri dediğimiz teknolojiler yarın için geri kalacaktır ve hiçbir zaman en son, en uç noktaya ulaşılamayacaktır.
Zaten ameliyatlarda bütün sorunların çözüldüğü bir teknolojik seviyede olsak yeni teknolojiler asla geliştirilemeyecektir.
Bütün bu teknolojik gelişmelerin getirdiği avantajları ameliyatlarımda kullanıyorum ama şu gerçeği de hiçbir zaman göz ardı etmiyorum.
“en iyi cihaz, en son teknoloji, kullanmasını bilmeyen için felaketlerle sonuçlanabildiği gibi,
en demode cihazlar, aletler usta ellerde çok iyi sonuçlar doğurabilir.”

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