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A new tool for cartilaginous hump reduction
British Jourd of Plastic Surgery (1990). 43, 384-385 0 1990 The Trustees of British Association of Plastic Surgeons
Ideas and Innovations A new tool for cartilaginous
hump reduction
N. S. NIRANJAN Plastic Surgery Unit, Guy’s Hospital, London
Summary-A cartilaginous
simple and cheaplv made instrument hump in aesthetic ihinoplasty.
is described which
aids accurate reduction
of the
Hump reduction is one of the important stages in aesthetic rhinoplasty. The technique requires experience to achieve an accurate reduction and it is often difficult for a trainee to know how much should be removed. Although it is possible to draw a line on the skin over the nose in order to indicate the amount of the hump to be removed, once the ala is retracted it is difficult to visualise accurately the level of excision corresponding to this line. When the hump is removed by a scalpel or scissors, a common error is to resect too much rather than too little.
Materials and method
Fig. 1
Instrument (Fig. 1) The special knife is made from a stainless steel cutlery knife by cutting the tip into a central cutting blade (8 x 4.5 mm) and a flange, the width of which should be about 7-8 mm. The lips of the flange are bent down to clasp the jaws of a DeBakey vascular clamp.
Method The amount of hump and alar cartilage to be removed is outlined over the nose (Fig. 2). The approach is through transcartilaginous or intercartilaginous incisions. The incisions are then extended downwards and forward, separating the columella from the caudal end of the septum by cutting through the membranous septum. Soft tissue over the hump is elevated with scissors. The hump and the caudal end of the septum are thus exposed. The upper lateral cartilages near the septum are approached extramucosally and divided from the
Figure l-The
special knife and the clamp.
septum. Now the septum can be visualised completely. A vascular clamp (DeBakey’s multipurpose clamp-jaw 60” angle) is applied to the septum (Figs 3 and 4). The jaws of the clamp can be felt through the nasal skin and manoeuvred into position corresponding to the line drawn on the nose. The cartilaginous hump is divided with the specially designed knife which slides over the jaws of the vascular clamp (Fig. 5). The bony hump is then removed with an osteotome. The technique is summarised diagrammatically in Figure 6. Conclusion The technique described in this paper is simple and accurate. The knife is a useful tool for trainees or anyone who practises aesthetic rhinoplasty.
384
Figure Z-The corresponding the clamp
amount of hump to be removed is marked over the nose. Figure %The ala is retracted and the clamp applied to the line drawn over the skin. Figure &The clamp in place. Figure S-The special knife sliding along the jaws of
Acknowledgement The author wishes to thank Mr A. E. Marshall, surgical instrument maker, Guy’s Hospital, who made the knife according to the specifications from a dinner knife.
The Author N. S. Niraqjan, MS, FRCS, FRCSEd, Locum Consultant Surgeon,
Guy’s Hospital,
St Thomas
Plastic Street, London SE1 9RT.
Requests for reprints to: Mr N. S. Niranjan, Galleywood, Chelmsford, Essex CM2 8QW. Paper received 26 June 1989. Accepted 21 August 1989.
e
Fig. 6 Figure &The
steps of the procedure.
2 Chaplin
Close,
Ideas and Innovations A new tool for cartilaginous
hump reduction
N. S. NIRANJAN Plastic Surgery Unit, Guy’s Hospital, London
Summary-A cartilaginous
simple and cheaplv made instrument hump in aesthetic ihinoplasty.
is described which
aids accurate reduction
of the
Hump reduction is one of the important stages in aesthetic rhinoplasty. The technique requires experience to achieve an accurate reduction and it is often difficult for a trainee to know how much should be removed. Although it is possible to draw a line on the skin over the nose in order to indicate the amount of the hump to be removed, once the ala is retracted it is difficult to visualise accurately the level of excision corresponding to this line. When the hump is removed by a scalpel or scissors, a common error is to resect too much rather than too little.
Materials and method
Fig. 1
Instrument (Fig. 1) The special knife is made from a stainless steel cutlery knife by cutting the tip into a central cutting blade (8 x 4.5 mm) and a flange, the width of which should be about 7-8 mm. The lips of the flange are bent down to clasp the jaws of a DeBakey vascular clamp.
Method The amount of hump and alar cartilage to be removed is outlined over the nose (Fig. 2). The approach is through transcartilaginous or intercartilaginous incisions. The incisions are then extended downwards and forward, separating the columella from the caudal end of the septum by cutting through the membranous septum. Soft tissue over the hump is elevated with scissors. The hump and the caudal end of the septum are thus exposed. The upper lateral cartilages near the septum are approached extramucosally and divided from the
Figure l-The
special knife and the clamp.
septum. Now the septum can be visualised completely. A vascular clamp (DeBakey’s multipurpose clamp-jaw 60” angle) is applied to the septum (Figs 3 and 4). The jaws of the clamp can be felt through the nasal skin and manoeuvred into position corresponding to the line drawn on the nose. The cartilaginous hump is divided with the specially designed knife which slides over the jaws of the vascular clamp (Fig. 5). The bony hump is then removed with an osteotome. The technique is summarised diagrammatically in Figure 6. Conclusion The technique described in this paper is simple and accurate. The knife is a useful tool for trainees or anyone who practises aesthetic rhinoplasty.
384
Figure Z-The corresponding the clamp
amount of hump to be removed is marked over the nose. Figure %The ala is retracted and the clamp applied to the line drawn over the skin. Figure &The clamp in place. Figure S-The special knife sliding along the jaws of
Acknowledgement The author wishes to thank Mr A. E. Marshall, surgical instrument maker, Guy’s Hospital, who made the knife according to the specifications from a dinner knife.
The Author N. S. Niraqjan, MS, FRCS, FRCSEd, Locum Consultant Surgeon,
Guy’s Hospital,
St Thomas
Plastic Street, London SE1 9RT.
Requests for reprints to: Mr N. S. Niranjan, Galleywood, Chelmsford, Essex CM2 8QW. Paper received 26 June 1989. Accepted 21 August 1989.
e
Fig. 6 Figure &The
steps of the procedure.
2 Chaplin
Close,