This can be a natural feature or secondary to injury. Usually after reduction of a nasal hump, the nasal bones need to be fractured in, which narrows the nose. A wide alar base seen most commonly in Afro-Caribbean patients can be improved by alar wedge resection.
Fracture of the nasal bones (osteotomies) is carried out using special sharp chisel like instruments called osteotomes. A common technique involves making 1 mm stab incisions on either side of the nose. Then a 2 mm osteotome is used to make a series of breaks along the sides of the nose rather like holes around a postage stamp. This allows a controlled break of the nasal bones. A new technique is the use of powered osteotomies. This utilises small saws and allows precise linear cuts to be made in the nasal bones.
In patient’s with weak nasal bones or those who have had previous trauma, the exact position of the fracture line is unpredictable and can result in floating pieces of nasal bones (comminutated fracture). Although the nasal cast applied over the nose at the end of the procedure helps to keep the pieces stable, subsequent healing can result in migration of the bone fragments giving an unsatisfactory result.
All fractured boned heal by initial formation of a material called callus. This then remodels to resume the normal shape but sometimes callus formation is excessive and/or the remodelling stage is inadequate so a prominence is noted in the post-operative result possibly requiring minor revision procedure. In rare instances a narrowed nose can result in nasal obstruction as the physical space in the nasal cavity is reduced.