External rhinoplasty – DNB Theory Long Question/ VIVA/ OSCE

External rhinoplasty – DNB Theory Long Question

Specific indications for the external approach in rhinoplasty include:

1. Congenital deformities such as the cleft nose;
2. Extensive revision surgery;
3. Severe nasal trauma;
4. Elaborate reduction & augmentation procedures;
5. Marked tip deformities;
6. The need for extra tip rotation;
7. The correction of extreme overprojection;
8. Situation where assessment of the exact pathology is difficult.
9. It has been advocated for nasoseptal perforation repair.

Anatomy of nose

Anatomical subunit of nose, which are conveniently divided into thirds.

1. The bony pyramid consisting of the nasal bones with their articulation to the ascending(frontal) process of the maxilla & bony septum constitutes the upper third.
2. The paired upper lateral cartilages insert just under the caudal end of the nasal bones & their fusion with the midline cartilaginous septum in a T type confuration forms the middle third(vault).
3. The scroll attachment of the caudal aspect of the upper lateral cartilage to the cephalic aspect of the lower lateral cartilages forms the boundary to the lower third of the nose. The paired lower lateral cartilages form the nasal tip & are traditionally divided into the lateral, intermediate & medial crurae.

The dome & tip forming points lie within the intermediate crus.

The medial crural footplate extend to the lower aspect of the columella & lie just anterior to the caudal aspect of the nasal septum.

 Principles of external rhinoplasty

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