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LogoCorpus7

4.A typical nose operation

1.The Incision

Incision inside the nose

Incisions only at the inside the nose. The operation is partially done without seeing all the structures.

 

Transcolumellar incisions

A combination of incisions inside with a short external scar going over the columella. This affords a very good view on the tip and the bridge.The columellar incision is barely noticeable after a few weeks.

This is my favorite incision type.

2.Dissection of the skin

The skin is largely released from the underlying structures both on the tip and the bridge of the nose. It allows for a precise trimming of cartilage and precise reduction of a hump with a small chisel.

3.Dissection of the mucosa.

Whenever needed- e.g. to harvest cartilage from the septum for grafting to the tip, the mucosa is carefully dissected.

4.Removal of a hump

To lower the bridge of the nose, an incision of the cartilaginous part is done first with a scalpel. Then the bony part is chiseled off with a small sharp chisel. Both cartilage and bone are removed in one piece. The irregularities left after the removal of the hump are then filed to have a smooth surface.

5.Lateral fracture

After the removal of the hump, the nasal pyramid has an open roof, as seen in the drawing. It needs to be closed by tilting both bony sides towards the midline by fracturing the bone at the base of the pyramid. This manoeuvre is called a lateral osteotomy.

Tekening van afgetopte pyramide en verschuiving door laterale osteotomie

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6.Dissection of the septum

If the septum is part of the problem, it can be dissected from the mucosa on both sides and corrected appropriately.

7. Modifying the tip

Both methods of removing or adding cartilage are standard procedures in tip surgery. These methods serve the following purposes :

8.Correction of the lip-tip angle

The angle can be corrected by a resection of the lower part of the septal cartilage

10.Surgery of the nostrils

Mainly wedge resection of wide nostrils

11.Sutures and splint

Inner and outer incisions are closed with fine sutures

In case of fracture of the nose, a splint is applied. It is made either of plaster or of plastic. It will keep the fragments in place until healing.

11.Sutures and splint

Inner and outer incisions are closed with fine sutures

In case of fracture of the nose, a splint is applied. It is made either of plaster or of plastic. It will keep the fragments in place until healing.

 

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