Plugs of gauze contract and harden, thus overcoming the object of their use and cause a disturbance of the wounds and pain when reapplied.
The pins should not be withdrawn until the nose has healed into its new position, or begin to cause irritation of the parts punctured.
Where the deviation is unilateral it should be corrected by subcutaneous injection, as previously described.
UNDUE PROMINENCE OF NASAL PROCESS OF THE SUPERIOR MAXILLARY
The protuberance of bone lies external to the middle meatus, involving an abnormal convexity of the nasal process of the superior maxillary. Its external removal or reduction involves considerable tissue and would leave a conspicuous linear scar, therefore the surgeon must attempt its reduction from the inner nose.
The author prefers to make a horizontal incision below the inferior border of the process, beginning anteriorly just before the articulation with the nasal bone and extending backward as far as the view from the nare will allow.
Through this opening, the skin overlying the bone is raised by dull dissection. A fine nasal saw is next introduced through the submucous wound and several vertical incisions are made into or even through the bone about three sixteenths of an inch apart, dividing the convexed osseous tissue into several sections adherent at their superior extremity which lies inferior to the insertion of the levator labii superioris alæque nasi muscle.
A forceps, such as Adams’s, is now introduced and each section of bone thus made is fractured from below upwards inwardly to produce a concavity of the osseous tissue.
The operation requires considerable dexterity. The amplitude of the sawing movement is very much restricted, because of the palpebral muscular attachment just above.
A frail bone cutting forceps may be employed and the lower half of the process be removed to avoid encroachment upon the middle meatus, but this is rarely necessary, as that chamber is found unusually wide in this case. If the bone is removed, the remaining bone may be cut into sections, as described, or by the cutting forceps, and fractured backwards as described.