Open structure rhinoplasty

Open structure rhinoplasty is a surgical technique used to reshape and reconstruct the nose. It involves creating an external incision to provide better visibility and access to the nasal structures. Here’s a detailed description of the procedure:

Preoperative Planning

1. Consultation: The patient meets with the surgeon to discuss their goals and expectations. The surgeon evaluates the nasal structure, skin type, and facial proportions.
2. Facial Analysis:
   1. Anthropometric Measurements: Precise measurements of nasal length, width, projection, and angles (nasofrontal, nasolabial, and nasofacial angles).
   2. Skin Quality: Assessment of skin thickness, elasticity, and sebaceous characteristics, which influence healing and final outcome.
3. Functional Evaluation:
   1. Breathing Assessment: Evaluation of nasal airflow and obstruction.
   2. Septal Deviation: Detailed examination of any septal deviations contributing to breathing issues.
4. Imaging: Photos and sometimes computer imaging are used to plan the surgery and simulate potential outcomes.
5. Medical Evaluation: A thorough medical history and examination are conducted to ensure the patient is a good candidate for surgery.

Anaesthesia

• General Anaesthesia: Typically, the patient is placed under general anaesthesia to ensure comfort and safety throughout the procedure.

Surgical Procedure

1. Incision:
   • A small incision is made across the columella (the tissue between the nostrils) and extended into the nostrils. This is known as a trans-columellar incision.
   • This approach provides direct access to the underlying nasal structures.
2. Elevation of Skin:
   • The skin and soft tissues of the nose are gently lifted off the underlying framework of bone and cartilage.
   • This exposes the nasal structures, allowing for precise modifications.
3. Reshaping the Cartilage and Bone:
   • Dorsal Hump Reduction: If there is a prominent dorsal hump, it is carefully reduced using rasps, chisels, or other instruments.
   • Tip Refinement: The cartilage of the nasal tip (lower lateral cartilages) can be reshaped, reduced, or augmented to achieve the desired contour.
   • Nasal Width Adjustment: If the nose is too wide, the nasal bones can be fractured and repositioned (medial and lateral osteotomies) to narrow the nose.
   • Septum Correction: If there is a deviated septum or breathing issues, the septum can be straightened (septoplasty) to improve airflow.
4. Grafting:
   • Cartilage Grafts: Cartilage from the septum, ear, or rib may be used to reinforce and support the nasal structure. Common grafts include spreader grafts, alar batten grafts, and columellar strut grafts.
   • These grafts provide structural support and help achieve the desired shape.
5. Closing the Incisions:
   • Once the desired changes are made, the skin is redraped over the new framework.
   • The external incision is meticulously closed with fine sutures to minimize scarring.

Postoperative Care

1. Splinting and Packing:
   • A nasal splint is applied to maintain the new shape and protect the nose during initial healing.
   • Internal nasal packing or splints may be used to support the septum and control bleeding.
2. Recovery:
   • The patient may experience swelling, bruising, and discomfort, which are managed with medications and cold compresses.
   • Follow-up visits are scheduled to monitor healing and remove any non-dissolvable sutures, splints, or packing.
3. Long-term Healing:
   • Swelling gradually subsides over several months, and the final results may take up to a year to become fully apparent.
   • The patient is advised to avoid strenuous activities, heavy lifting, and any trauma to the nose during the healing period.

Advantages of Open Rhinoplasty

• Visibility: Provides excellent visualization of the nasal structures, allowing for precise modifications.
• Versatility: Suitable for complex cases, including significant deformities, revisions, or extensive reshaping.
• Control: Enhanced control over the reshaping process, especially for the nasal tip and dorsal structures.

Disadvantages

• Scarring: Although minimal, there is a small external scar on the columella.
• Swelling: May result in more postoperative swelling compared to closed techniques.
• Recovery Time: Slightly longer recovery time due to the more extensive surgical approach.

Overall, open structure rhinoplasty is a highly effective technique for achieving significant and precise nasal corrections, with the trade-off of a small external scar and potentially longer recovery.