An assistant separates the wounds with hook tenaculi, exposing the osseous bridge, as in [Fig. 471].
Fig. 470. Fig. 471. Fig. 472.
Median Nasal Incision.
The author advocates dividing the periosteum and dissecting it well back to either side of the bony elevation. By bringing it back over the denuded surface after the chiseling has been done, it aids materially in establishing a smooth surface and hastens the bone repair.
The periosteum being held aside, the straight chisel and mallet are used to reduce the bone. The operator may proceed to do this from above down or vice versa, according to the formation and position of the protuberance.
The redundant cartilage is removed with the knife from above downward, cutting from side to side.
Usually the operator does not remove enough of the cartilage and a new angulation of the nose appears after the swelling has disappeared, necessitating a second operation.
The wound is closed as shown in [Fig. 472].
Lateral Incision.—The incision in this case is made slightly posterior to the beginning of the lateral border, as shown in [Fig. 473].