Fig. 480. Fig. 481.
Author’s Method.
Before suturing the wounds, it is advisable to free the skin of the inferior lobule to overcome tension.
The sutures are applied as in [Fig. 481]. None are used to unite the mucosa unless the interior wounds are large enough to permit of their use.
CORRECTION OF MALFORMATIONS ABOUT THE NASAL LOBULE
The operations herein described apply particularly to the correction or reduction of an overprominent nasal tip due to an excessive growth of congenital malformation of that part of the nose, giving the organ undue prominence and a hooklike appearance, usually associated with a narrow, sharply upward inclined upper lip.
Pozzi Method.—The same operation, on a larger scale, can be readily employed for the correction of hyperplasia nasi and rhinophyma.
In the operation of Pozzi (Bulletin et mémoire de Société de chirurgie, 1897, p. 729) an elliptical section of skin and cartilage are removed from the lobule with its widest part corresponding to the point of the nose; the cicatrices occasioned thereby are practically as bad, if not worse, than the unscarred overprominent nose, while the submucous procedure of Roe (Medical Record, July 18, 1891) is not only insufficient in these cases, but, according to my experience, practically useless.
Roe Method.—Roe’s method requires a submucous extirpation of the redundant cartilage at the tip through a necessarily small opening within the nasal orifice, also the division in several places of the anterior fold of the lower lateral cartilage with the object of reducing the undue convexity of the alæ. The latter is, we might say, impossible, since the cartilages will be reduced by such a method, even under pressure dressings, which are likely to cause gangrene of the skin of the wings; or if this be avoided, the cicatrix resulting from such division usually restores the very fault that it is expected to overcome, while the mucous lining of the alæ becomes thickened and more firmly tied down than previous to the operation.
One is tempted to exsect the major curvature of the lower lateral cartilage, but this leads to a flattening of the wings of the nose, partial atresia of the nasal orifice, and a decided lack in its symmetry.