Oh God what happened to my Nose-Post Traumatic nasal deformity can be devastating

Picture1Out of all the facial features the nose out stand and so as Nasal deformities.Some people are born with bad nose some have a deformed nose after a trivial trauma in Childhood  but those who had a good looking face and nose ,when they get a unexpected nasal disfigurement it is sever Psychological Shock.

At the time of initial trauma bleeding, head injury and other life threatening conditions have priority ,Nose is not very important at that time usually managed by Junior on call doctors or not so experienced doctors, after the initial period these otherwise normal persons when they see themselves in mirror they have severe psychological disturbances.When all the wounds heal the Nasal disfigurement remains and affects the over all personality,many times functional problems such as Nasal blockage and sinusitis which the patient never experienced can appear.This man with a post traumatic nasal deformity covers his face whenever goes out of house.

Case 1-One soft ware engineer had a accident head injury facial trauma was hospitalized for several days recovered from head injury ,the nasal fracture was reduced ,after the healing completed ,he had a sever saddle nose deformity hated himself for the disfigured face , left job and confined himself inside house,

Case -2 A house wife survived in a major Car accident lost a closed family member  ,primary care was given at the site and moved to a large hospital several days of hospitalization ,attempted Fracture nasal bone reduction  but left with a ugly depressed nose. She adopted a deep silence and stopped talking to any one except the bare minimum .Otherwise a beautiful  lady disfigured nose after accident seeing a psychiatrist and taking anti depressant

Case 3-A factory worker injured his nose on work deep cut and multiple fracture ,sever bleeding ,fracture reduction with repair of lacerated wound done but left with a sever depressed crooked nose with nasal obstruction

Case 4- A young man had a sever facial trauma with scared forehead and totally collapsed nose-He was ridiculed by his friends and family even his wife used to pass nasty comments ,He was considered as unlucky man by the villagers so much that he considered committing suicide but stopped short because of young children.A  gave him his life back

Nasal reconstruction

Secondary Rhinoplasty in these cases have limitation ,a thorough counselling is required and they should understand they may not achieve the pre injury nose, the scars may be less visible but they cannot disappear

Steps of surgery-

1)Exposure-Even if there is a scar on dorsum try to expose the nasal frame work through a External Rhinoplasty Exposure

2)Open up the septum and assess the abity of the septum to support the nose,partly damaged septum can be restrenthen  if there are multiple fractures it is important to  build a nasal frame work which is strong and stable,the pieces of septal cartilage/Ethmoid/vomer are very useful graft material and can be used to built up the entire nose,a rib cartilage provides a strong and stable foundation and is used a invisible graft for making the nasal frame work

3)Septal perforation can be repaired at this stage

4)A floating columellar strut gives mobility to tip as well improves tip projection

5)Dorsum Augmentation-can be done by cartilage/diced cartilage/facia-A scarred skin can be expanded only up to a limit resit the temptation to achieve the perfect nose.You can augment only as much the skin permit avoid using dorsal rib cartilage grafts they very often curls and give a crooked appearance to the dorsum

6)Facial blanket below the skin-Temporalis fascia/Fascia Lata used underlying a severely scarred and damaged skin helps in giving a smooth contour ,masks graft outline which might be visible several months after the initial surgery

7)Scar Revision -If required should be done in the end

see the VDO on You tube

Picture31sadd24trauma

 

 

Most of these patients are very grateful if we can bring them even close to their appearance before the accident.One of the most exciting moment of my life when the Husband of one of my patient called me in late evenning ,saying doc thanks After many months I saw a smile on my wifes face.Thanks for giving back her real life

Our website-www.cosmeticrhinoplastyindia.com

Akash Nose clinic Bicholi Mardana ,Indore,India Tel-91-731-2496038,4064080,09926564989

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