The bone plates are fastened to each side of the frontal flap by suture.
The nasal base is preferably made of the tissue remaining of the old nose, as depicted, to prevent closure of the nostrils, the only difficulty being to keep the poorly nourished tissue from dying. When used the raw surface is brought in contact with that of the frontal flap.
The objection in this case is that the median third anterior line usually falls in rapidly, leaving the nose dished or saddled, and unless there be sufficient tissue to construct the base, the objections so often referred to heretofore will occur.
Fig. 406.—First step.
Fig. 407.—Showing separation and elevation of nose flaps.
Langenbeck Method.
Ch. Nélaton Method.—This author uses an osteo-cutaneous flap taken from the forehead. The shape of the latter is shown in [Fig. 408].
The lateral incisions are to be made the width of a finger from the margins of the old nose, extending upward in curved fashion through the inner edge of the eyebrows and meeting at a point on the forehead, becoming slightly oblique near the border of the hair.
The flap is dissected up from the borders inward, including the periosteum, leaving a strip of bony attachment at the median line.