External
nasal deformity
Anomalies of the shape of the nose may be
congenital or acquired. The latter may be the result of trauma, previous nasal
surgery or destructive processes such as Wegener’s granulomatosis. Correction
of a deformity of the bony nasal complex is referred to as a rhinoplasty
procedure and if combined with a procedure to correct a deviation of the nasal
septum the procedure is known as a septo rhinoplasty. In a standard rhinoplasty
procedure the nasal bones are approached through an intercartilagenous incision
between the upper and lower lateral cartilages within the nasal fossa and the
soft tissues covering the nasal skeleton are elevated. Superior and lateral
osteotomies are used to mobilise the nasal bones, which are then repositioned to
produce a pleasing shape to the nose. This procedure can also be carried out
through an external approach where the skin of the columella is divided
allowing elevation of the soft tissues of the tip of the nose to provide access
to the nasal bones and septum. With adequate exposure by either method a dorsal
hump can be removed with hammer and chisel and a saddle nose deformity can be
corrected by dorsal augmentation using either bone from the iliac crest,
harvested septal cartilage or a suitably shaped sialastic implant. Cosmetic
deformities of the soft tissues of the tip of the nose require the specialised
surgical techniques of a facial plastic surgeon.