Plastic and cosmetic surgeryKolle, Frederick Strange
Science
Plastic and cosmetic surgery
Kolle, Frederick Strange
Surgery, Plastic
The great fault in injecting so large a quantity as is necessary in these
cases is to make the nose too wide from the very beginning, which, added
to the widening following the replacement by new tissue, makes the shape
of the nose unsatisfactory.
For this reason it will be found of some benefit to apply an anterior
nasal splint of aluminium, covered interiorly with a fold of white
flannel or gauze and pressed into such shape that when applied to the
nose it will keep the latter pinched up laterally to the desired width.
This splint will hardly ever be borne by a patient and causes great
discomfort until after the post-operative reaction has subsided. It may
then be bandaged or held in place by strips of Z. O. Adhesive plaster for
an hour or two in the day and during the entire night.
After the first few days’ wearing the patient soon becomes accustomed
to the splint. It should be worn as mentioned for about three weeks,
when the patient may be permitted to pinch the nose laterally with his
fingers two or three times a week or more.
The secondary injection may be made in the ordinary way or as advocated
by the author in the manner described in correcting defects of the
inferior third of the nose.
=Inferior Half Deficiency.=—In this type of deformity the greater point
of nondevelopment or deficiency is found at the upper extremity of the
cartilage of the septum, below its articulation with the inferior border
of the nasal bones, and involving to a greater extent the area over the
upper lateral cartilages.
This deformity, due to whatever cause, rarely affects the base or
inferior part of the nose, owing undoubtedly to the greater protection
and stability offered by the lower lateral and sesamoid cartilages and
the dense cellular tissue making up the alæ. Except in such cases where
violence of an extreme nature has been exerted in early life, or where
ulcerative disease has broken down most of the cartilage of the septum,
the point of the nose is usually normal in size and shape. In the latter
cases there is an upper tilt of the lobule and a shortening of the
columna upon itself with a convexity in an upward direction.
The cause of this type of deformity is usually a direct blow upon the
point of the nose, syphilitic ulceration internally, catarrh, or other
ulcerative disease.
When due to violence the point of the nose may or may not present a
normal appearance, there may be a normal base tilted upward (retroussé or
snout nose) or a dropping forward and downward (hook or beak nose).
The shape of the nasal base depends much upon the time of life the injury
was received—that is, before or long after puberty, also upon the extent
of injury inflicted and where applied.
From injuries received early in life we may look to a lack of development
in the cartilage of the septum alone, or associated with deficiency in
one or both lateral cartilages.
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