Laboratory Studies
See the list below:
-
Obtain benzoylecgonine levels for patients in whom cocaine abuse is suspected to exclude recent cocaine use. Such patients should have abstained from cocaine use for more than a year.
-
A complete blood count, serologic tests for syphilis, a tuberculin skin test, rheumatoid factor, and an erythrocyte sedimentation rate are helpful in determining infectious or autoimmune etiologies.
-
Aerobic, anaerobic, and acid-fast cultures of nasal secretions may be indicated.
-
An antineutrophil cytoplasmic antibody test, if positive, is highly specific for Wegener granulomatosis.
Imaging Studies
See the list below:
-
Preoperative photographs should be taken from at least 4 different views. Most surgeons prefer 6 standard views, including frontal, right and left laterals, right and left obliques, and basal views.
-
Although not mandatory, preoperative radiography or CT scanning may indicate the extent of bone or cartilage loss.
-
Chest radiography is helpful in determining infectious or autoimmune etiologies.
-
Although plain radiographic studies and CT scanning often are performed around the time of trauma to the nose and mid face, these studies are not essential for reconstruction of the short nose. Using a careful physical examination to determine the amount of bony and cartilaginous deficiency is more reliable.
Other Tests
See the list below:
-
Acoustic rhinometry is often used to verify subjective descriptions of nasal obstruction.
Diagnostic Procedures
See the list below:
-
A tissue biopsy may be necessary to confirm the presence of neoplastic or autoimmune disease. Biopsies for this indication are notoriously unreliable, however. Biopsy is probably best performed when cancer is strongly suspected.
-
Typical short nose deformity.
-
Concept of facial thirds. The distance from the hairline to the glabella approximately should equal the distance from the glabella to the base of the nose. In turn, this distance should approximate the distance from the base of the nose to the lowest point on the chin.
-
Nasal length (NL) represents the distance from the nasal radix to the tip. Radix height (RH) measures the distance from the dorsum to the cornea on lateral view. Nasal height (NH) measures the distance from the radix to the base of the nose.
-
Three of the best methods of analyzing projection: (A) the nasofacial angle, (B) the Crumley and Landser method, (C) the Goode method.
-
Three methods of analyzing tip rotation. Method A may be affected by chin position or a sloping forehead. Method C is inaccurate if the maxilla protrudes or if the columella is in an abnormal position. Method B is probably the most accurate, but it is difficult to employ on the operating table.
-
The normal flow of air through the nose should be laminar and parabolic. In the short nose, airflow typically breaks up into eddy currents, creating more resistance.
-
Demonstration of the nasal tripod concept. As with a tripod, if the lateral legs (lateral crura) of the nasal tip are shortened, the tip rotates upward. Upward rotation also occurs if the central leg (conjoined medial crura) is lengthened. Downward rotation occurs if the opposite maneuvers are carried out. Projection is altered by increasing or decreasing the lengths of all the legs concomitantly. With most short noses, the goal is to derotate the tip, and many operations attempt to lengthen the lateral legs of the tripod.
-
The columellar strut. This is a common way to restore or increase tip projection, which is typically deficient in the short nose.
-
One method of lengthening the lateral legs of the tripod is to insert cartilage or composite grafts into the area illustrated. This should derotate the tip and increase projection.
-
Use of interlocking calvarial bones to restore integrity of the collapsed nose. The dorsal strut is secured with screw(s) to the native bony dorsum. The caudal strut fits in a slot drilled in the dorsal strut. A small screw in the caudal strut acts as a stop to prevent retrodisplacement of either strut.
-
Two pieces of calvarial bone. One will be fashioned to serve as the caudal strut and the other as the dorsal strut.
-
Large permanent suture to anchor the dorsal bone strut to the periosteum around the nasal spine.
-
Dorsal strut in place. This will be modified to allow for the proper nasal tip projection.
-
Preoperative profile view.
-
Preoperative frontal view.
-
Postoperative profile view.
-
Postoperative frontal view.
-
Preoperative profile view.
-
Preoperative frontal view.
-
Postoperative profile view.
-
Postoperative frontal view.
