Plastic and cosmetic surgeryKolle, Frederick Strange
Science
Plastic and cosmetic surgery
Kolle, Frederick Strange
Surgery, Plastic
Some authorities have injected noses of this type from the point of
the nose, but it will be found that the position of the puncture at
this point allows a considerable portion of the mass to work out during
molding and also to permit of the readier oozing out of the mass during
the pressure exerted by what reactive inflammation follows the operation.
This is accounted for by the fact that the needle creates a tubelike
canal in the tightly bound down tissue overlying the lower lateral
cartilages, whereas in the lateral punctures the short canal is easily
displaced by the swelling, thus causing its obliteration and preventing
the free oozing.
On the other hand, it will be found to be more difficult to inject
from the point of the nose alone and that a very long needle has to be
used which must be withdrawn as the parts above the point are filled.
Furthermore, it will be found necessary to thrust the point of the needle
in different directions to overcome vertical attachments of the skin
which are more readily lifted up than thrust aside by the mass, hence
necessitating a greater amount of injury to the tissues, not to speak of
the possibility of injecting transverse blood vessels higher up in the
nose of which the operator would not be aware at the time; showing only
in the resultant phlebitis and unexpected reactive symptoms, associated
with a discoloration more or less lasting according to the extent of
obliteration of the vessels.
The post-operative treatment should be as heretofore advised.
=Lateral Insufficiency= (_Unilateral and Bilateral_).—Depressions about
the sides of the nose are usually due to hereditary causes, when they
are likely to be bilateral, yet intranasal ulcerations may cause a
falling-in, as it were, of either one or both nasal walls, involving
in such instances the entire side or part of it. In the partial cases
the depression may be in any of the division of thirds used by the
author—that is, it may lie laterally over the region of the nasal bone
and such of the nasal process of the superior maxillary bone as goes
to make up that part of the nose, or in the middle third below the
bone structure and above the superior limitation of the lower lateral
cartilages, or within the lower third over the inferior border of the
cellular tissue making up the nasal rim.
Traumatism may be found to be the cause of such depressions, especially
in the middle third, after fracture or luxation of the nose. In such
cases the defect is usually unilateral or at the seat of the former
injury, a convexity usually being exhibited on the opposite side.
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