Wide nasal tip: causes, symptoms, diagnosis, treatment

A wide nasal tip is a deformation that can be caused by an increase in the angle between the medial and lateral crura of the large cartilages of the wings of the nose or the radius of the arc formed by the transition of the lateral crura to the medial crura. Therefore, the elimination of the widening of the nasal tip is reduced to excision of the excess of the large cartilages of the wings of the nose or to suturing the diverged medial crura of these cartilages.

Treatment of a wide nasal tip

An operation to excise excess large cartilages of the nasal wings at the transition points of the medial crura to the lateral ones (according to the method of G. I. Pakovich). The operation is completed by suturing the skin wound, tamponade of the nose and application of a collodion dressing. However, the author does not recommend suturing the remnants of the cartilages of the nasal wings for the following reasons:

1. when they are stitched together, excess mucous membrane is formed in the form of folds that protrude into the nasal passages (c, d); this reduces the size of the nasal passages and leads to deformation of the tip of the nose after surgery;
2. catgut nodes in the area of the tip of the nose are very slowly absorbed and in some cases become overgrown with connective tissue, protruding under the skin in the form of tubercles. In order to avoid recurrence of the defect, G. I. Pakovich recommends completely excising the large cartilages of the wings of the nose, leaving only the medial crura, which determine the normal height of the nasal septum. Such excision of cartilages does not cause, according to the author's observations, retraction of the wings of the nose, which are formed by a subcutaneous scar, as well as under the influence of nasal tamponade and collodion dressing. This operation is contraindicated for children.

In case of widening of the tip of the nose due to divergence of the medial crura of the large cartilages of the wings of the nose, the tissue located between the diverged medial crura is excised and 1-2 mattress catgut sutures are applied, the knots of which are tied between the cartilages. The operation is completed as in the previous version.

For corrections of the tip of the nose, A. S. Shmelev suggests the following method. Through a wave-shaped incision on the tip of the nose, strictly along the edge of the nasal passages, with a gradual transition to the column, the skin is widely peeled off in the area of the tip, back and wings of the nose; this allows the entire operation to be carried out under visual control, maintaining symmetry, more correctly and evenly distributing the peeled skin on the newly modeled tip of the nose.

Insufficient skin detachment limits the possibility of correct excision of its excess. Then the cartilaginous flaps from the lateral and medial crura of the large cartilages of the wings of the nose are mutually moved.

The cartilages are crossed in the area of the transition of the lateral crura to the medial crura, i.e. in the dome-shaped part; in the area of the lateral crura, the mucous membrane is widely peeled off, leaving it only at the base in an area measuring 0.5-0.7 cm.

Next, the connective tissue is excised with a small area of cartilage in the area where the lateral pedicle transitions into the triangular cartilage to avoid tissue layering on the triangular cartilages when they cross.

The amount of tissue excised depends on the degree of hypertrophy of the large cartilages of the wings of the nose and the degree of deformation of the tip of the nose: the greater it is, the more tissue is excised.

Next, the right cartilaginous flap, formed from the right lateral pedicle of the large wing cartilage, is fixed with catgut to the left medial pedicle, and the left cartilaginous flap is sutured to the right medial pedicle, throwing it over the right cartilaginous flap.

The excess cartilaginous tissue of these flaps is excised in such a way that no sharp angles remain. The more significant the deformation, the more tissue is removed. In cases where the cartilaginous flaps are located excessively wide in the area of the tip of the nose, these flaps are incised in the proximal sections (in order to “loosen” the elasticity of the cartilage). The cartilaginous framework of the tip of the nose modeled by this method rests on the cartilage of the nasal septum. The skin above this framework is carefully lowered and distributed on the tip of the cartilage, its excess is excised with an incision running parallel to the lower edge of the wound formed by the skin incision.

Excess nasal mucosa is not excised, since after 6-8 months it contracts on its own without deforming the nose.

7-9 hair or plastic sutures are applied, gauze tampons are inserted into the nose, and a collodion fixing bandage is applied to the nose (according to G.I. Pakovich).

The stitches are removed after 4-5 days, and the collodion dressing after 8-10 days (the more traumatic the operation, the later).