Fig. 443
Souchon’s intranasal inhaler.
OPERATIONS ON THE NOSE.
Plastic operations upon the nose appear to have been practised early in the history of surgery. The East Indians had a method by which the skin of the forehead was made to furnish a flap from which a new nose was created. This was known as the Indian method. It has been somewhat modified of late years by raising with the skin flap the periosteum, or, as suggested by König, the outer table of the frontal bone, with the intent and hope that something resembling the nasal bone might be secured. The so-called Italian method (named the Tagliacotian operation, after Tagliacozzi) consists in utilizing the skin of the arm, which is loosened according to a pattern previously made, leaving it connected only by a pedicle through which its blood supply is to be afforded. This flap is usually cut out and perfectly formed, then left loose upon the arm for about fifteen days until its viability has been thoroughly proved and its under surface is granulating. Then the edges of the defect in the nose are pared, as well as those of the flap, and the arm is brought into such position as to allow fitting the latter to the former, where it is held by stitches. The arm is held in proper position by cushions and by bandages of plaster of Paris until union has taken place, after which the pedicle is severed and the arm then released.
Fig. 444
“Saddle-nose” due to syphilitic destruction of bone. (Lexer.)
Lesser deformities of the nose may be remedied or repaired in various ways. Angular deformities may be excised, while a sunken bridge may be raised, as Weir has suggested, through a bevelled incision at the junction of the nasal and maxillary bones, they being held in place by a transfixion pin. One of the most common and objectionable deformities is the so-called saddle-nose, which may be treated by Weir’s method, or which has afforded satisfactory results after the injection of paraffin. Roe, of Rochester, New York, has succeeded in remedying many of the more trifling nasal deformities by operation from within the nose, as, for instance, in case of pug-nose, where he dissects from within superfluous fat and connective tissue ([Fig. 444]).