Rhinoplasty

Rhinoplasty (ῥίς rhis, nose + πλάσσειν plassein, to shape), commonly known as a nose job, is a plastic surgery procedure for correcting and reconstructing the nose. There are two types of plastic surgery used – reconstructive surgery that restores the form and functions of the nose and cosmetic surgery that improves the appearance of the nose. Reconstructive surgery seeks to resolve nasal injuries caused by various traumas including blunt, and penetrating trauma and trauma caused by blast injury. Reconstructive surgery also treats birth defects, breathing problems, and failed primary rhinoplasties. Most patients ask to remove a bump, narrow nostril width, change the angle between the nose and the mouth, as well as correct injuries, birth defects, or other problems that affect breathing, such as deviated nasal septum or a sinus condition.Rhinoplasty: Nasal Class I. The Roman nose. (Nasology Eden Warwick, 1848)Rhinoplasty: Nasal Class II. The Greek nose. (Nasology Eden Warwick, 1848)Rhinoplasty: Nasal Class III. The African nose. (Nasology Eden Warwick, 1848)Rhinoplasty: Nasal Class IV. The Hawk nose. (Nasology Eden Warwick, 1848)Rhinoplasty: Nasal Class V. The Snub nose. (Nasology Eden Warwick, 1848)Rhinoplasty: Nasal Class VI. The celestial nose. (Nasology Eden Warwick, 1848)Photograph A. Open rhinoplasty: Pre-operative, the guidelines (purple) ensured the surgeon's accurate incisions in cutting the nasal defect correction plan.Photograph B. Open rhinoplasty: Post-operative, the taped nose, prepared to receive the metal nasal splint that immobilizes and protects the newly corrected nose.Photograph C. Open rhinoplasty: The metal nasal splint aids wound healing by protecting the tender tissues of the new nose.Photograph D. Open rhinoplasty: The taped, splinted, and dressed nose completes the rhinoplasty.Rhinoplastic instruments: Bone-scraping rasps, of various grades and types, that the plastic surgeon uses to refine the corrections required to produce a new nose.Rhinoplastic instruments:An osteotome (bone chisel) and a surgical hammer for sculpting craniofacial bones. Rhinoplasty (ῥίς rhis, nose + πλάσσειν plassein, to shape), commonly known as a nose job, is a plastic surgery procedure for correcting and reconstructing the nose. There are two types of plastic surgery used – reconstructive surgery that restores the form and functions of the nose and cosmetic surgery that improves the appearance of the nose. Reconstructive surgery seeks to resolve nasal injuries caused by various traumas including blunt, and penetrating trauma and trauma caused by blast injury. Reconstructive surgery also treats birth defects, breathing problems, and failed primary rhinoplasties. Most patients ask to remove a bump, narrow nostril width, change the angle between the nose and the mouth, as well as correct injuries, birth defects, or other problems that affect breathing, such as deviated nasal septum or a sinus condition. In closed rhinoplasty and open rhinoplasty surgeries – an otolaryngologist (ear, nose, and throat specialist), an oral and maxillofacial surgeon (jaw, face, and neck specialist), or a plastic surgeon creates a functional, aesthetic, and facially proportionate nose by separating the nasal skin and the soft tissues from the nasal framework, correcting them as required for form and function, suturing the incisions, using tissue glue and applying either a package or a stent, or both, to immobilize the corrected nose to ensure the proper healing of the surgical incision. Treatments for the plastic repair of a broken nose are first mentioned in the Edwin Smith Papyrus, a transcription of an Ancient Egyptian medical text, the oldest known surgical treatise, dated to the Old Kingdom from 3000 to 2500 BCE. Rhinoplasty techniques were carried out in ancient India by the ayurvedic physician Sushruta (no dating available), who described reconstruction of the nose in the Sushruta samhita (no archaeological evidence available), his medico–surgical compendium. The physician Sushruta and his medical students developed and applied plastic surgical techniques for reconstructing noses, genitalia, earlobes, etc., that were amputated as religious, criminal, or military punishment. Sushruta also developed the forehead flap rhinoplasty procedure that remains contemporary plastic surgical practice. In the Sushruta samhita compendium, Sushruta describes the (modern) free-graft Indian rhinoplasty as the Nasikasandhana. During the Roman Empire (27 BC – 476 AD) the encyclopaedist Aulus Cornelius Celsus (c. 25 BC – 50 AD) published the 8-tome De Medicina (On Medicine, c. 14 AD), which described plastic surgery techniques and procedures for the correction and the reconstruction of the nose and other body parts. At the Byzantine Roman court of the Emperor Julian the Apostate (331–363 AD), the royal physician Oribasius (c. 320–400 AD) published the 70-volume Synagogue Medicae (Medical Compilations, 4th century AD), which described facial-defect reconstructions that featured loose sutures that permitted a surgical wound to heal without distorting the facial flesh; how to clean the bone exposed in a wound; debridement, how to remove damaged tissue to forestall infection and so accelerate healing of the wound; and how to use autologous skin flaps to repair damaged cheeks, eyebrows, lips, and nose, to restore the patient's normal visage. Nonetheless, during the centuries of the European Middle Ages (5th–15th centuries AD) that followed the Imperial Roman collapse (476 AD), the 5th-century BC Asian plastic surgery knowledge of the Sushruta samhita went unknown to the West until the 10th century AD, with the publication, in Old English, of the Anglo-Saxon physician's manual Bald's Leechbook (c. 920 AD) describing the plastic repair of a cleft lip; as a medical compendium, the Leechbook is notable for categorizing ailments and treatments as internal medicine and as external medicine, for providing herbal medical remedies, and for providing supernatural incantations (prayers), when required. In the 13th century AD, at Damascus, the Arab physician Ibn Abi Usaibia (1203–1270) translated the Sushruta samhita from Sanskrit to Arabic. In due course, Sushruta's medical compendium travelled from Arabia to Persia to Egypt, and, by the 15th century, Western European medicine had encountered it as the medical atlas Cerrahiyet-ul Haniye (Imperial Surgery, 15th century), by Şerafeddin Sabuncuoğlu (1385–1468); among its surgical techniques featured a breast reduction procedure. In Italy, Gasparo Tagliacozzi (1546–1599), professor of surgery and anatomy at the University of Bologna, published Curtorum Chirurgia Per Insitionem (The Surgery of Defects by Implantations, 1597), a technico–procedural manual for the surgical repair and reconstruction of facial wounds in soldiers. The illustrations featured a re-attachment rhinoplasty using a biceps muscle pedicle flap; the graft attached at 3-weeks post-procedure; which, at 2-weeks post-attachment, the surgeon then shaped into a nose. In time, the 5th-century BC Indian rhinoplasty technique—featuring a free-flap graft—was rediscovered by Western medicine in the 18th century AD, during the Third Anglo–Mysore War (1789–1792) of colonial annexation, by the British against Tipu Sultan, when the East India Company surgeons Thomas Cruso and James Findlay witnessed Indian rhinoplasty procedures at the British Residency in Poona. In the English-language Madras Gazette, the surgeons published photographs of the rhinoplasty procedure and its nasal reconstruction outcomes; later, in the October 1794 issue of the Gentleman's Magazine of London, the doctors Cruso and Findlay published an illustrated report describing a forehead pedicle-flap rhinoplasty that was a technical variant of the free-flap graft technique that Sushruta had described some twenty-three centuries earlier.