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Nasal reconstruction an ancient art.

When a portion considers undergoing nasal surgery, whether it be reconstructive or aesthetic, he or she has the confidence that the procedure will be performed by a top-flight medical team using the most advanced equipment and techniques available.

But the cornerstone of all nasal surgery, also known as rhinoplasty, rests on the shoulders of a technique that was developed in India around 800 B.C. "The technique of taking a flap of skin from the forehead and reconstructing a nose from the skin was originated by a group called the Koomas Potters," explains Fred Fedok, M.D., assistant professor of otolaryngology at Penn State's Milton S. Hershey Medical Center. "The technique was developed because, at the time, the punishment for some crimes in India was amputation of the nose. People who lost their noses for a crime searched out individuals who could create a prosthetic nose. The Koomas Potters had the ability, based on their skill at creating shape and form in their work with clay."

The process has come a long way since that time, and today, many otolaryngologists/facial plastic surgeons and plastic surgeons consider the rhinoplastic technique an art, as well as a science. It is a craft that not only works at creating a new nose for a person, but also strives to mimic or recreate all the functional and aesthetic aspects of the patient's original nose. "Many of our major reconstructive and corrective techniques are based on the original Indian forehead flap and articles published in 1931 by Jacques Joseph, an orthopaedist," says Fedok. "What otolaryngologists and plastic surgeons have done since that time is to increase the level of skill we have acquired and lessen the risk of complications to the patient. The process continues to evolve.

"The nose serves many important functions," adds Fedok. "Aside from the obvious respiratory and olfactory functions creating our ability to breath and detect odors, the nose has a very important social function. In its central position on the face, the nose becomes an important aspect of every visual social interaction. There is a wide range of 'normal' regarding nasal shapes and sizes that are socially acceptable. Deformities may occur when these variations reach extremes or when there is an absence of a nose because of tumors, trauma and congenital deformities. Symmetry is detected by patients on the scale of millimeters. Our goal, whether we are performing a major nasal reconstruction or performing a less complicated corrective or aesthetic nasal surgery is to accomplishment normality for the patient -- both in form and function."

According to Fedok, major nasal reconstruction not only relies on the flap of skin removed from the forehead, but also small grafts of bone and cartilage removed from other parts of the body. "Nasal reconstruction is one of the most delicate procedures we perform," says Fedok. "It takes a great amount of skill and creativity, so it is important for professionals in the field to share their knowledge."

Because of the need to share these technical breakthroughs in rhinoplasty, otolaryngologists and plastic surgeons meet regularly to discuss ongoing changes in nasal surgery.

Fedok believews that although advances in rhinoplasty have come at the hands of surgeons, the general public has also played a role in a surgeon's ability to get better and better results. "The public has demanded that we, as professionals, be able to offer them a normal nose following surgery," says Fedok.
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Publication:Nutrition Health Review
Date:Jun 22, 1993
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