Pressure splints and manual compression should be employed as in the preceding deformity.
The reaction following the first injection is likely to be severe. Cold applications, as previously referred to, are indicated, and should be continued for at least two days.
Care should be taken not to inject into the lateral vessels, which usually lie on a line with the juncture between the lateral and lower lateral cartilages. If this should happen, the point of the nose at once assumes a bluish hue, and there is more or less pain felt at once, with considerable swelling a few hours after the injection. Later, every symptom of gangrene of the lobule is liable to be noticed, yet with faithful attention to furthering the circulation of the parts by either cold or hot applications, the active inflammatory symptoms usually subside in ten to fourteen days, leaving the patient with a whole nose, more or less colored at the lobule, according to the state of the circulation and the exposure of the parts to the various temperatures. This may be overcome in time, yet it may persist for years, depending entirely upon the ability of the anastomosing vessels to overcome the artificial thrombus or occlusion offered by the mass injected.
That a reaction quite similar in character, but of milder degree, is likely to be seen when one of these vessels has not been injected, can be readily understood when we consider that a hard and somewhat ungiving mass is made to overlie the vessels themselves. The symptoms just described in such case are apt to be noted much later, even several hours after the injection, because the swelling has then begun to add its pressure to that of the mass in obstructing the flow of blood to the lobule. Such condition may be termed pressure occlusion in contradistinction to thrombotic obstruction.
These symptoms usually subside in a day or two, or with the swelling caused by the reaction.
If the symptoms appear at once after the injection, it is best to force out as much of the injected mass as is possible through the needle hole through which it has been introduced.
Fig. 298a. Fig. 298b.
Anterior, Superior and Inferior Third Nasal Deficiency and Correction Thereof.