It is not here intended to lay down a law for the surgeon for the restoration of the entire or part of the nose for the reason that each case differs more or less; that in each case there is more or less tissue that may be utilized, and that there are many methods advanced for such procedure, but the author does desire to give to the operator a concise and comprehensive treatise on rhinoplasty and to illustrate the best of such operations as have been placed on record as a ready guide and for immediate reference—a matter of no small moment when this literature can be gained only by searching through innumerable medical journals and short references and in all languages of the civilized world.
In the chapter on history some idea of the time in which rhinoplasty has been practiced may be obtained. It is not deemed necessary to go into further historical facts here, except, perhaps, to divide the subject into the three most important schools or countries that have given individuality to the art.
THE CAUSES OF NASAL DESTRUCTION
The loss of the entire nose may be due to traumatism, actual amputation, the bites of man or beast, duels, the removal of neoplasms, gangrene after freezing or disease, rhinosclerosis, syphilis, the application of caustics, tubercular disease, lupus, cancer, and rarely congenital absence of the organ. The loss may be total or partial.
The extent of loss of substance in each case differs, and it is for this reason that surgeons have been compelled to originate many methods of operation, each having for its object to correct the deformity as neatly and as near to the normal as possible.
CLASSIFICATION OF DEFORMITIES
To give correctly a classification of nasal deformities would simply mean to mention each anatomical part or division of the nose referring to the deformity involving the same. For this reason such an arrangement would be uselessly extensive, but for the proper recording of such cases the author advises a systematic method of nomenclature in which the deformity is stated, as: left, unilateral deficiency of inferior lobule; or right, median third deficiency of nasal dorsum of the parts destroyed and mentioned as such.
Fig. 306.—Deficiency of Superior and Middle Third of Nose. (Saddle Nose.)