Correcting damaged bone and cartilage support.
Injuries to the nose frequently lead to damage to the bone and cartilage support, and change the appearance of the nose, resulting in deviations, asymmetries and sometimes airway problems.
Deviations of the bones and cartilages of the nose can be reset with a relatively good success rate within the first week to 10 days after the injury.
The main worry is that injury to the nose can generate bleeding on both sides of the nasal septum, and the blood clots that accumulate around the cartilage deprive it of blood supply and the cartilage then dies. This situation, referred to as septal haematoma, can be treated as an emergency, and when the haematoma is evacuated promptly after injury, the cartilage in the septum is protected.
Loss of the cartilage support from the septum under the bridge of the nose, creates the saddle nose deformity or boxer nose deformity.
It is important to understand that following a more significant injury to the nose, it takes six months or longer before more extensive corrective surgery can be undertaken safely. This is primarily to allow the tissues to settle, become softer and less vascular.
When evaluating the nose after an injury, considerations of shape and airway are both very important, and sometimes a septo rhinoplasty is necessary, in order to achieve improvements in all areas.
In order to restore a straighter contour of the nose, it is often necessary to reshape and reposition the bones using ultrasonic instruments, and re-align the cartilages. Where support has been lost, rib cartilage grafts are used to rebuild it.
A detailed plan of changes is necessary, and computer simulation can bring invaluable assistance. With more complex corrections, the open tip approach provides the benefits of improved exposure and ability to stabilise the structures inside the nose, which represent the supporting framework of cartilage and bone.
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Areas of particular concern are the presence of a bump on the bridge of the nose, excessive width of the bridge or tip of the nose, and possibly excessive width of the nostrils.
Augmentation rhinoplasty refers to the type of surgery where the dimensions of the nose are increased.
The term has been associated with rhinoplasty for population groups with softer nasal contours, like the Afro-Caribbean, East Asian and South-East Asian populations.
Deviations of the bones and cartilages of the nose can be reset with a relatively good success rate within the first week to 10 days after the injury.
Secondary (revision) rhinoplasty is a more complex procedure, for patients who had surgery in a different centre and would like to improve upon the outcome.
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