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History

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The term rhinoplasty is derived from the Greek word “rhinos” which means nose and “plastikos” which means “to shape.” Rhinoplasty is surgery that changes the appearance of the nose. More recently, the term “functional rhinoplasty” has been used to describe surgery that, in addition to changing appearance, also improves the function. Nasal reconstruction was first described in Ancient India by Sushruta in his text Sushruta Samhita circa 500 BC. Sushruta, considered to be the father of plastic surgery, used a variety of techniques to reconstruct nasal amputations, a common form of capital punishment at the time. These included pedicled, rotation flaps of the cheek and forehead. In the late 1500s, Professor Gaspare Tagliacozzi published a surgical textbook in Bologna showing nasal reconstruction using a flap from the upper arm. In the mid-1800s, Johann Freiderich Dieffenbach further refined the plastic surgical procedures of his time in his textbook titled Operative Surgery. He described techniques to reduce the size of the nose, such as excising a portion of abnormally enlarged nasal ala and making cruciate excisions of skin and cartilage. Aesthetic rhinoplasty though an intranasal approach was first described by American otolaryngologist John Orlando Roe in 1887 in his landmark article “The deformity termed ‘pug nose” and its correction by a simple operation.” In the late 1800s, Jacques Joseph arose as one of the most important figures in facial plastic surgery and was the pioneer of modern rhinoplasty. Joseph gave numerous lectures and practical courses on rhinoplasty that were attended by surgeons like Gustave Aufricht, Joseph Safian, Jacques Maliniac, John Maurice Converse, and Samuel Fomon. Fomon then began teaching a rhinoplasty course based upon Joseph's techniques. Two notable otolaryngologists who attended the courses were Maurice Cottle and Irving Goldman. As these surgeons trained other surgeons and surgical techniques became more refined, modern rhinoplasty was developed.

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Essentials of Diagnosis

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  • The nose is made up of nine subunits—nasal dorsum, tip, columella, the paired nasal sidewalls, ala/sills, and soft triangles
  • The three major tip support mechanisms are the strength and integrity of the lower lateral cartilages, and their attachments to the septum and to the upper lateral cartilages
  • The internal and external nasal valves account for much of the nasal resistance to airflow and must be accounted for when performing rhinoplasty.

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Surface Anatomy

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The external surface of the nose is divided into nine subunits. They consist of the nasal dorsum, tip, columella, the paired nasal sidewalls, ala/sills, and soft triangles. The subunit principle described by Burget and Menick is based upon the notion that the human eye detects the shadowed valleys and lighted ridges of the nasal surface. This principle applies equally in nasal cosmetic surgery and in nasal reconstruction. In cancer or trauma, if more than 50% of a nasal subunit is lost, the remainder of the subunit should be removed. Thus, the whole subunit is replaced with scars designed to ...

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