Nose Surgery ENT Red Bank NJ 07701
The surgical management of nasal defects and deformities divides the nose into six (6) anatomic subunits: (i) the dorsum, (ii) the sidewalls (paired), (iii) the hemilobules (paired), (iv) the soft triangles (paired), (v) the alae (paired), and (vi) the columella. Surgical correction and reconstruction comprehend the entire anatomic subunit affected by the defect (wound) or deformity, thus, the entire subunit is corrected, especially when the resection (cutting) of the defect encompasses more than 50 per cent of the subunit. Aesthetically, the nose — from the nasion (the midpoint of the nasofrontal junction) to the columella-labial junction — ideally occupies one-third of the vertical dimension of the person’s face; and, from ala to ala, it ideally should occupy one-fifth of the horizontal dimension of the person’s face. Nose surgery ENT Red Bank NJ 07701.
The nasofrontal angle, between the frontal bone and the nasion usually is 120 degrees; the nasofrontal angle is more acute in the male face than in the female face. The nasofacial angle, the slope of the nose relative to the plane of the face, is approximately 30–40 degrees. Thenasolabial angle, the slope between the columella and the philtrum, is approximately 90–95 degrees in the male face, and approximately 100–105 degrees in the female face. Therefore, when observing the nose in profile, the normal show of the columella (the height of the visible nasal aperture) is 2 mm; and the dorsum should be rectilinear (straight). When observed from below (worm’s-eye view), the alar base configures an isosceles triangle, with its apex at the infra-tip lobule, immediately beneath the tip of the nose. The facially proportionate projection of the nasal tip (the distance of the nose’s tip from the face) is determined with the Goode Method, wherein the projection of the nasal tip should be 55–60 per cent of the distance between the nasion (nasofrontal junction) and the tip-defining point. A columellar double break might be present, marking the transition between the intermediate crus of the lower-lateral cartilage and the medial crus.
The Goode Method determines the extension of the nose from the facial surface by comprehending the distance from the alar groove to the tip of the nose, and then relating that measurement (of nasal-tip projection) to the length of the nasal dorsum. The nasal projection measurement is obtained by delineating a right triangle with lines parting from the nasion (nasofrontal juncture) to the alar–facial–groove. Then, a second, perpendicular delineation, that traverses the tip-defining point, establishes the ratio of projection of the nasal tip; hence, the range of 0.55:1 to 0.60:1, is the ideal nasal-tip-to-nasal-length projection. Nose surgery ENT Red Bank NJ 07701.
To determine the patient’s suitability for undergoing a rhinoplasty procedure, the surgeon clinically evaluates him or her with a complete medical history (anamnesis) to determine his or her physical and psychological health. The prospective patient must explain to the physician–surgeon the functional and aesthetic nasal problems that he or she suffers. The surgeon asks about the ailments’ symptoms and their duration, past surgical interventions, allergies, drugs use and drugs abuse (prescription and commercial medications), and a general medical history. Furthermore, additional to physical suitability is psychological suitability — the patient’s psychological motive for undergoing nose surgery is critical to the surgeon’s pre-operative evaluation of the patient. In the case of men, the surgeon must identify prospective patients presenting the mental traits denoted by the psychiatric acronymSIMON (single, immature, male, over-expectant, and narcissistic), which might indicate a man over-valuing the outcome of a rhinoplasty. Nose surgery ENT Red Bank NJ 07701.
The complete physical examination of the rhinoplasty patient determines if he or she is physically fit to undergo and tolerate the physiologic stresses of nose surgery. The examination comprehends every existing physical problem, and a consultation with an anaesthesiologist, if warranted by the patient’s medical data. Specific facial and nasal evaluations record the patient’s skin-type, existing surgical scars, and the symmetry and asymmetry of the aesthetic nasal subunits. The external and internal nasal examination concentrates upon the anatomic thirds of the nose — upper section, middle section, lower section — specifically noting their structures; the measures of the nasal angles (at which the external nose projects from the face); and the physical characteristics of the naso-facial bony and soft tissues. The internal examination evaluates the condition of the nasal septum, the internal and external nasal valves, the turbinates, and the nasal lining, paying special attention to the structure and the form of the nasal dorsum and the tip of the nose.
Furthermore, when warranted, specific tests — the mirror test, vasoconstriction examinations, and the Cottle maneuver — are included to the pre-operative evaluation of the prospective rhinoplasty patient. Established by Maurice H. Cottle (1898–1981), the Cottle maneuver is a principal diagnostic technique for detecting an internal nasal-valve disorder; whilst the patient gently inspires, the surgeon laterally pulls the patient’s cheek, thereby simulating the widening of the cross-sectional area of the corresponding internal nasal valve. If the maneuver notably facilitates the patient’s inspiration, that result is a positive Cottle sign — which generally indicates an airflow-correction to be surgically effected with an installed spreader-graft. Said correction will improve the internal angle of the nasal valve and thus allow unobstructed breathing. Nonetheless, the Cottle maneuver occasionally yields a false-positive Cottle sign, usually observed in the patient afflicted with alar collapse, and in the patient with a scarred nasal-valve region. Nose surgery ENT Red Bank NJ 07701.
The plastic surgical correction of congenital and acquired abnormalities of the nose restores functional and aesthetic properties by the surgeon’s manipulations of the nasal skin, the subcutaneous (underlying) cartilage-and-bone support framework, and the mucous membrane lining. Technically, the plastic surgeon’s incisional approach classifies the nasal surgery either as an open rhinoplasty or as a closed rhinoplasty procedure. In open rhinoplasty, the surgeon makes a small, irregular incision to thecolumella, the fleshy, exterior-end of the nasal septum; this columellar incision is additional to the usual set of incisions for a nasal correction. In closed rhinoplasty, the surgeon performs every procedural incision endonasally (exclusively within the nose), and does not cut the columella.
- Procedural differences
Except for the columellar incision, the technical and procedural approaches of open rhinoplasty and of closed rhinoplasty are similar; yet closed rhinoplasty procedure features:
- Reduced dissection (cutting) of the nasal tissues — no columellar incision
- Decreased potential for the excessive reduction (cutting) of the nasal-tip support
- Reduced post-operative edema
- Increased availability for effecting in situ procedural and technical changes
- Palpation that allows the surgeon to feel the interior changes effected to the nose
- Shorter operating room time
- Quicker post-surgical recovery and convalescence for the patient
- The "ethnic nose"
The open rhinoplasty approach affords the plastic surgeon the advantages of ease in securing the grafts (skin, cartilage, bone) and, most important, in seeing the nasal cartilages proper, and so make the appropriate diagnosis. This procedural aspect can be especially difficult in revision surgery, and in rhinoplastic corrections of the thick-skinned “ethnic nose” of the colored man or woman. The study, Ethnic Rhinoplasty: a Universal Preoperative Classification System for the Nasal Tip (2009), reports that a nasal-tip classification system, based upon skin thickness, has been proposed to aid the surgeon in determining if an open rhinoplasty or a closed rhinoplasty shall best correct the defect or deformity afflicting the patient’s nose. Nose surgery ENT Red Bank NJ 07701.
Etiologically, the open and closed approaches to rhinoplastic correction resolve: (i) nasal pathologies (diseases intrinsic and diseases extrinsic to the nose); (ii) an unsatisfactory aesthetic appearance (disproportion); (iii) a failed primary rhinoplasty; (iv) an obstructed airway; and (v) congenital nose defects and deformities. Nose surgery ENT Red Bank NJ 07701.
- Congenital abnormalities
- Cleft lip and palate in combination; cleft lip (cheiloschisis) and cleft palate (palatoschisis), individually.
- Congenital nasal abnormalities
- Genetically derived ethnic-nose abnormalities
Acquired abnormalities such as:
- Allergic and vasomotor rhinitis — inflammations of the mucous membrane of the nose caused by an allergen, and caused by circulatory and nervous system disorders.
- Autoimmune system diseases
- Bites — animal and human
- Burns — caused by chemicals, electricity, friction, heat, light, and radiation.
- Connective-tissue diseases
- Inflammatory conditions
- Nasal fractures
- Naso-orbito-ethmoidal fractures — damages to the nose and the eye-sockets; and damage to the bones and the walls of the nasal cavity; it is the ethmoid bone that separates the brain from the nose.
- Neoplasms — malignant and benign tumors
- Septal hematoma — a mass of (usually) clotted blood in the septum
- Toxins — chemical damages caused by inspired substances — e.g. powdered cocaine, aerosol antihistamine medications, et cetera.
- Traumatic deformities caused by blunt trauma, penetrating trauma, and blast trauma.
- Venereal infection — e.g. syphilis