Wide tip of the nose: causes, symptoms, diagnosis, treatment
Last reviewed: 18.10.2021
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The wide tip of the nose is a deformation that can be caused by an increase in the angle between the medial and lateral legs of the large cartilages of the nose wings or the arc radius formed by the transition of the lateral legs into the medial ones. Therefore, the removal of the extension of the tip of the nose is reduced to excising the excess of large cartilage of the wings of the nose or to the stitching of the split medial legs of these cartilages.
Treatment of a wide tip of the nose
The operation of excision of excess large cartilage of the wings of the nose at the sites of the transition of the medial legs to the lateral (according to the method of GI Pakovich). Complete the operation by suturing the cutaneous wound, tamponade the nose and applying a collodion bandage. However, the author does not recommend stitching the remains of the cartilage of the wings of the nose for the following reasons:
- when they are sewn up excess mucous membranes are 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;
- the nodes of the catgut in the region of the tip of the nose very slowly resolve and in some cases become overgrown with a connective tissue, protruding under the skin in the form of tubercles. To avoid recurrence of the defect, GI Pakovich recommends completely excising the large cartilages of the wings of the nose, leaving only the medial legs, which determine the normal height of the septum of the nose. Such excision of cartilage does not cause, according to the author's observations, the westernization of the wings of the nose, which are formed by the subcutaneous scars, as well as under the influence of the tamponade of the nose and the collodion bandage. This operation is contraindicated for children.
In case of widening of the tip of the nose due to the divergence of the medial legs of the large cartilages of the nose wings, the fiber, located between the divergent medial legs, is excised, and 1-2 mattress catgut sutures are inserted, the nodules of which are tied between the cartilages. Finish the operation, as in the previous version.
To correct the tip of the nose, AS Shmelev suggests the following procedure. Through a wavy cut at the tip of the nose, strictly along the edge of the nasal passages, with a gradual transition to the column, the skin is often exfoliated in the tip, back and wings of the nose; this allows you to conduct the entire operation under visual control, observing symmetry, more correctly and evenly distributing the exfoliated skin on the newly modeled tip of the nose.
Inadequate skin detachment limits the possibility of correct excision of excess. Then, the cartilaginous flaps from the lateral and medial legs of the large cartilages of the wings of the nose are mutually moved.
Cartilages cross in the region of the transition of the lateral legs into the medial ones, i.e. In the dome-shaped part; in the region of the lateral legs, the mucous membrane is widely exfoliated, leaving it only at the base in a section 0.5-0.7 cm in size.
The connective tissue is then excised with a small portion of the cartilage in the area of the lateral pedicle transition into the triangular cartilage to avoid layering the tissues onto the triangular cartilages when they cross.
The amount of excised tissue depends on the degree of hypertrophy of the large cartilage of the wings of the nose and the degree of deformation of the tip of the nose: the larger it is, the more tissue is excised.
Next, the right cartilaginous flap, formed from the right lateral leg of the large cartilage of the wing, is fixed to the left medial pedicle with the catgut and the left cartilaginous flap is sutured to the right medial leg, transferring it through the right cartilaginous flap.
Surplus cartilage tissue of these flaps are excised in such a way that there are no sharp corners. The more pronounced the deformation, the more tissue is removed. In cases where the cartilaginous flaps are located excessively wide at the tip of the nose, incisions are made in these flaps in the proximal areas (to "loosen" the cartilage elasticity). Modeled by this method, the cartilaginous skeleton of the tip of the nose rests on the cartilage of the septum of the nose. The skin above this skeleton is gently lowered and distributed at the tip of the cartilage, the excess is excised by a cut parallel to the lower edge of the wound that formed when the skin is cut.
Excess of the nasal mucosa is not excised, because after 6-8 months it self-contracting, without deforming the nose.
7-9 hair or plastic seams are applied, gauze swabs are inserted into the nose, a collodion fixation bandage is placed on the nose (according to GI Pakovich).
Remove the stitches after 4-5 days, and the collodion bandage - after 8-10 days (the more traumatically the operation took, the later).