Fig. 294. Fig. 295.
Anterior Median Third Nasal Deficiency and Correction Thereof.
It is not uncommon to find a dividing wall of subcutaneous tissue about the articulation of the nasal bones and cartilages, as evidenced by a rising up or down of the injected mass above or below this line. If this be found, rather than break down this wall with the injection, it is deemed advisable to inject each chamber separately and mold the two masses after injection, as in the ordinary type of cases.
Inferior Third Deficiency.—This deformity of the nose is due purely to a lack of development or a luxation of the cartilage of the septum and the upper lateral cartilages. The point or lobule of the nose is usually tilted upward and the subseptum curved upward at its middle third.
The cause of this deformity is usually due to direct violence at some time in life, with improper replacement at the time of injury. Syphilis and intranasal catarrh, lupus and ulcerative diseases, are also causes.
The skin overlying the defect may or may not be closely adherent, but is in most cases rather thickened and inelastic. It is therefore necessary, in most cases, to loosen the skin by subcutaneous dissection, done as already described before the injection is made.
To rebuild such a nasal defect without dissection, except in such instances where the skin is quite elastic, is not to be advised, since the injected mass would be flattened, more or less, antero-posteriorly, giving the nose a broad and ugly appearance after the connective-tissue formation has been attained.
It is with cases of this kind that paraffin injections introduced in the liquid form and of high melting points are usually expelled in a week or ten days, or even later, subsequent to a breaking down of the surrounding tissues and the resultant abscess.