Rhinoplasty

Definition

Cosmetic reconstruction of the external nose, which can be performed by a rhinoplasty specialist.

Discussion

• In addition to cosmetic effect, a rhinoplasty can be performed to alleviate nasal airway problems usually caused by a deviated septum or nasal trauma not corrected by the closed method.
• Five interrelated steps may be used:

• 1. Tip modeling and alr wedging (if indicated).
  2. Hump (bridge) removal
  3. Narrowing
  4. Septoplasty
  5. Turbinectomy

• The procedure must always be modified to meet the individual needs of the patient, and crucial to success is the maintenance of proper shape, symmetry, and proportion according to the size and shape of the face.
• The procedure is usually performed under local anesthesia with conscious I.V. sedation.

Positioning

• Supine with arms tucked in the sides.
• The head may be supported on a headrest.
• A nasal preparation is usually performed prior to begin the skin preparation.

Packs/ Drapes

• Head and neck pack or basic pack with split sheet and head drape.

Instrumentation

• Nasal procedure tray
• Basic plastic tray
• Beaver knife handle

Supplies/ Equipment

• Headrest
• Fiberoptic headlight and light source
• Suction
• Basin set
• Blades
• Beaver blades
• Needle counter
• Solutions
• Sutures
• Nasal preparation
• Nasal splint
• Antibiotic treatment

Procedure Overview

1. The surgeon operates within the nose, making an intercartilaginous incision along the rim of upper lateral cartilage bilaterally, freeing the skin from over the dorsal septum, and anteriorly, freeing the columella.
2. Prominent septal lateral and alar cartilage is excised and, following reassessment, the cartilage is trimmed as needed.
3. The nasal bones are then osteotomized laterally, medially, and horizontally (if needed), and compressed to infracture the bones, creating a more normal contour.
4. Rasping with smooth any existing irregularities and alignment of the septum is achieved.
5. The anterior septum and columella and the alar incisions are sutured, in addition to marginal incisions of the rim of the lower lateral cartilage.
6. Intranasal packing is inserted, usually consisting of a Gelfoam material or petrolatum-impregnated gauze.
7. An external splint made from plaster or other materials may be applied and the outside of the nose is taped for additional support.

Perioperative Nursing Considerations

1. Do not allow prep solutions to pool in or around the eyes and ears.
2. Keep tissue specimens moistened in saline solution.
3. The table may be turned and flexed for ease of access and patient comfort.
4. The nasal preparation tray may be set up on a clean, nonsterile Mayo tray, according to surgeon’s preference.