NARROWING OF THE WIDE NOSE

THE PROBLEMS that arise in the narrowing of the wide nose can be illustrated by a presentation of Joseph's1classic operation as found in his book: NARROWING OF THE BONY NASAL FRAMEWORK (RHINOSYSPASIS) This procedure is often necessary in conjunction with hump removal, because following the excision of a considerable hump the nose will be too wide if its lateral dimensions are left unchanged. The operation consists in the cutting of the upper maxilla along the dotted line, shown in Figure 1, and the shifting of the bony lateral wall toward the midline. This I accomplish intranasally (without external scarring) in the following manner: I introduce into one of the nostrils a straight double-edged knife and advance it into the lateral recess of the vestibule, directly beneath the nasolabial fold, to a depth which will permit the point to lie on the outer aspect of the upper maxilla. This