Rhinoplasty
As rhinoplasty ( ancient Greek ῥίς rhis - nose and Greek. Plattein - form, forms, shapes), also rhinoplasty or nose surgery , the surgical correction is the outer human nose, respectively. It is used to treat congenital changes in shape such as As a hump nose or injuries as crooked nose and saddle nose . The correction of nasal tip or nostril changes as part of cosmetic surgery also falls under this term. The surgical correction of the inner human nose is called septoplasty , and the frequent case of simultaneous correction of the inner and outer nasal framework is called septo-rhinoplasty . During rhinoplasty, excess body tissue such as B. the bones or cartilage of a nasal hump are removed ( nasal reduction plastic ), or destroyed or missing tissue is renewed or replaced by tissue transplantation ( nasal plastic , nasal replacement ).
history
Accidental or war injuries with considerable loss of substance from nasal tissue still require extensive skin shifts from the nasal area for reconstruction. Total nose loss was far more common in pre-Christian India, where chopping off the nose was a draconian punishment. Nasal reconstructions using skin from the forehead, the so-called Indian nasal plasty , have been used in India since around 400 BC. Performed. At the beginning of the 15th century, Branca the Elder performed a skin replacement with skin on the cheek and his son with a pedicle flap from the upper arm. In the 15th century, the surgeon Heinrich von Pfalzpaint described nasal replacement surgery by means of pedicled remote transplantation in 1460 . In the West, a manuscript by the Venetian traveler Niccolò Manucci (1638–1717), which contains an accurate description of Indian rhinoplasty, first caused a stir at the end of the 18th century . On this subject, the surgeon Friedrich Trendelenburg received his doctorate from the Humboldt University in Berlin in 1866 with a dissertation entitled De veterum Indorum chirurgia ( On the surgery of the ancient Indians ). A more complicated procedure than Heinrich von Pfalzpaint used in 1597 Gaspare Tagliacozzi .
The German surgeon Jacques Joseph (1865–1934), who operated on many soldiers during the First World War who had suffered severe facial injuries, is considered the founder of modern rhinoplasty . Joseph surgically reduced the size of a patient's nose for the first time in 1898 - a landowner who avoided social contact because of the oversize of his nose. At a congress in 1906, Joseph, who was increasingly gaining an international reputation as a pioneer of modern rhinoplasty, was able to report on 210 such operations. After the end of the war, Joseph was able to make his experience available to the distinguished Berlin society if nose reductions or other aesthetic facial corrections were desired. Joseph's methods of nose and facial surgery with their careful planning of the procedure before the operation , the new types of instruments and the simultaneous consideration of functional and aesthetic aspects became known and further developed in the USA in the 1920s. Joseph's basic methods and techniques have been used in modern rhinoplasty to this day.
Instead of using bones as a replacement for the nasal saddle, as was common at the time, the dentist Alfred Kantorowicz , who was active in Turkey, used ivory in his nose operations in Istanbul.
Surgical methods
In order to reach the nasal framework made of bones and cartilage and to be able to reshape it, an access must be made on the nose. A distinction is made here between closed or endonasal access , which was developed by Jacques Joseph, and open access. The pros and cons of these two techniques are the subject of controversial debate, not least among surgeons.
With a closed approach , the incision is only made on the nasal mucous membrane in the nose. The advantage of this is that no cuts and thus no scars remain on the outer nose.
With the open approach , the same incisions are made on the nasal mucosa as with the closed approach and are also connected with a step or V-shaped incision over the nasal bridge. This leaves a scar on the nasal bridge that heals finely and inconspicuously in approx. 90% of the cases, which the critics of the method consider to be superfluous. The advantages of the method are explained by the fact that after open access, the skin of the nose can be folded up like a bonnet, and the surgeon now has a direct view of the structures to be worked on. The advocates of this method emphasize that this is the only way to achieve maximum precision of the operation, which ensures an optimal and long-lasting result.
The consensus, however, is that equally good results can be achieved with both the endonasal (closed) and the open access. An advantage or disadvantage of one or the other method with regard to the expected result or the risk of reoperations or complications has not yet been scientifically demonstrated.
In the case of minor deformations, a nose correction with fillers such as hyaluronic acid or calcium hydroxylapatite is possible, for example to compensate for contour irregularities. Typical operation-related risks do not apply with this method. a. Skin redness, inflammation, swelling and bruising occur. The possible blindness of an eye, which can be caused by the infarction of retinal vessels, is feared. The effects last about twelve months on average.
Bridge of the nose
In western countries, a lowering of the bridge of the nose, i.e. a reduction in the height of the nose from the surface of the face, is usually desired, for example the removal of a hump, i.e. an increased elevation of the middle bridge of the nose compared to the upper and lower bridge of the nose. In Asian countries, on the other hand, an increase in the bridge of the nose is often desired. If the bridge of the nose is to be lowered, both the lower bridge of the nose, made of cartilage, and the upper bridge of the nose, made of bone, usually have to be removed. If this is done to a certain extent, it is advisable to then bring the bony side walls of the nose further inwards in order to close the so-called nose pyramid again after its tip has been removed. For this purpose, the bone is cut along the base of the nose with a fine chisel, either via an access in the nasal mucosa, from the oral cavity or via tiny cuts on the skin of the nose.
Tip of the nose
Various dimensions can be changed at the tip of the nose. The most common of these are the width of the tip of the nose, the height of the tip of the nose (in relation to the bridge of the nose), the so-called rotation of the nose tip, i.e. a more steeply hanging nose tip, or a snubby nose tip pointing upwards from the lip. The approaches of the nostrils and the curvature of the edges of the nostrils can also be changed. This usually requires shaping the so-called alar cartilages, which form the framework of the tip of the nose. As with all interventions that are intended to change the shape of the nose, it is important not to weaken the framework structure so much that the nasal breathing function is negatively affected.
For reconstruction of the nose , for example after tumor removal, but also for corrective operations after unsatisfactory previous operations, additional framework material is often necessary. For this purpose, the body's own cartilage ( autologous transplants ) is preferably used, which can be taken either from the nasal septum, the ear or also from the rib. The use of foreign materials such as specially structured polytetrafluoroethylene or silicone is only recommended in exceptional cases, as foreign bodies in the nose have a relatively high frequency of complications.
Depending on the extent of the operation and the associated risks, such as secondary bleeding, the operation can be carried out as an inpatient (3 to 4 days) or outpatient. Except in exceptional cases, the operation is performed under general anesthesia .
Most surgeons use nasal splints or plasters after surgery, especially if the bone has been altered. These are worn for 1–2 weeks. You are able to socialize and work after about two weeks.
Curvature of the septum
The procedure takes place through the nostrils. One tries to remove the wrongly positioned cartilage or bones of the nasal septum or to place it correctly by working under the nasal mucosa. In most cases the operation is performed under general anesthesia, but it can also be done under local anesthesia. There are different forms of curvature of the nasal septum. After the procedure, tamponage is placed in the nasal passages to stop the bleeding and to hold and splint the straightened nasal septum in the center of the nose. The doctor will remove the tamponade a few days after the operation.
Risks
According to a long-term study by the plastic surgeon Wolfgang Mühlbauer from 2001, 40 percent of the noses change in an undesirable way after the correction. According to this study, the best results are achieved at a young age, up to about 30 years.
Normal consequences of the procedure are slight bleeding and bruising as well as temporary sensory disturbances in the operating area. Light nosebleeds are relatively common. Infections are rare . Overgrown scars inside the nose can lead to a cicatricial hump ; the frequency is around five percent.
For the general risks of surgical interventions, see Operation (Medicine) .
literature
- Ronald D. Barley: Jacques Joseph - The Fate of the Great Plastic Surgeon and the History of Rhinoplasty. Kaden Verlag, Heidelberg 2015, ISBN 978-3-942825-33-7 .
- George C. Peck: nose surgery. Thieme, Stuttgart 1986
- Naumann et al .: Head and Neck Surgery. Volume 1. Thieme, Stuttgart 1995
Web links
Individual evidence
- ↑ Christoph Weißer: Nose plastic. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 1024.
- ↑ Christoph Weißer: The nasal replacement plastic after Heinrich von Pfalzpaint. A contribution to the history of plastic surgery in the late Middle Ages with an edition of the text. In: Josef Domes, Werner E. Gerabek , Bernhard D. Haage, Christoph Weißer, Volker Zimmermann (eds.): Light of nature. Medicine in specialist literature and poetry. Festschrift for Gundolf Keil on his 60th birthday. , Göppingen 1994 (= Göppinger works on German studies. Volume 585), pp. 485–506.
- ↑ Christoph Weißer: The nasal replacement plastic after Heinrich von Pfalzpaint. Original text from the 15th century in modern translation with commentary. In: Bulletin of the Association of German Plastic Surgery , No. 11, 1992, p. 14 f.
- ^ PJ Sykes, P. Santoni-Rugiu, RF Mazzola: Nicolò Manuzzi (1639-1717) and the first report of the Indian Rhinoplasty. In: J Plast Reconstr Aesthet Surg 63 (2010), pp. 247-250, 251-256
- ↑ Hans Killian : Master of surgery . 2nd Edition. Thieme, Stuttgart 1980, p. 140.
- ↑ Ronald D. Gerste: Jacques Joseph - The fate of the great plastic surgeon and the history of rhinoplasty . Kaden Verlag, Heidelberg 2015, ISBN 978-3-942825-33-7 .
- ↑ Behrbohm: 100 years of modern nose surgery . Eulogy
- ↑ Ali Vicdani Doyum: Alfred Kantorowicz with special reference to his work in İstanbul (A contribution to the history of modern dentistry). Medical dissertation, Würzburg 1985 (Commissioned by the publishing house Königshausen & Neumann, Würzburg), p. 240.
- ↑ Bernd Schuster: Injection Rhinoplasty with Hyaluronic Acid and Calcium Hydroxyapatite: A Retrospective Survey Investigating Outcome and Complication Rates. In: European Journal of Facial Plastic Surgery. 2015, pp. 301-307. hno-privatpraxis-münchen.de (PDF) accessed on May 30, 2016.
- ↑ Review article in the NZZ (2008)
- ↑ Curvature of the nasal septum surgery - What you need to know. (No longer available online.) Archived from the original on November 16, 2015 ; accessed on November 15, 2015 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
- ↑ Karin Willen: cosmetic surgery. Reinbek 2003, p. 16
- ↑ Karin Willen: cosmetic surgery. Reinbek 2003, p. 19
- ↑ Karin Willen: cosmetic surgery. Reinbek 2003, p. 18
