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.