Monk’s Method.—This author made a small incision through the skin just posterior to the inferior edge of the lobule, as in [Fig. 469a]. Then with a dull instrument, introduced through the opening, he detached the connecting tissue that binds the skin along the anterior dorsum as far as the root of the nose, giving more or less width to this freed area about the nasal bones.
A dull-pointed scissors is introduced through the sublobular opening, and the bones and cartilage are reduced until the desired nasal line has been attained.
The method of procedure is shown in [Fig. 469b].
Fig. 469a. Fig. 469b.
Monk’s Method.
The wound is cleansed of all spiculæ of bone or bits of cartilage and the skin opening is closed by suture. Healing takes place with more or less ecchymosis in about six days.
The difficulty the author finds with this method is that it is practically impossible to do good work with the scissors in this position.
The use of an electric drill has been advocated to do away with the scissors, but it is a dangerous instrument and requires great skill for its manipulation and reduces the bone particles to such fine fragments that much of it is left in the wound, which may induce sepsis or cause unevenness of the skin surface until later absorbed or removed. The same fault is observed with cartilage, which it grinds into pulpy pieces and for which it should never be used.
Anterior Median Incision.—This, perhaps the oldest method, has been extensively employed. The incision is made down the median line of the dorsum of the nose, beginning above the deformity, and ending slightly below the inferior bone line, as shown in [Fig. 470]. The skin is incised obliquely.