Rhinotomy

Bazaar art print from the Ravi Varma Press, 1920's - Surphanaka Nose cut off

Rhinotomy is a surgical procedure involving the incision into, or the dissection of, the nose. This operation can be performed for various medical reasons, including but not limited to, the removal of tumors, the correction of congenital defects, or the treatment of severe nasal blockages that cannot be managed with less invasive methods. The history of rhinotomy dates back to ancient times, with early references found in texts of ancient India and Egypt, where it was performed for both medical and ritualistic reasons.

Indications

Rhinotomy is indicated in several conditions affecting the nasal cavity and the sinuses. These conditions include:

• Nasal polyps or tumors that are inaccessible or cannot be completely removed through endoscopic surgery.
• Severe cases of nasal septum deviation that require more extensive reconstruction.
• Chronic rhinosinusitis that has not responded to medical treatment or less invasive surgical options.
• Traumatic injuries to the nose that result in complex fractures or obstruction.
• Congenital malformations of the nose that significantly affect function or appearance.

Procedure

The specific approach to rhinotomy can vary depending on the underlying condition being treated and the extent of the surgery required. Generally, the procedure involves the following steps:

1. Anesthesia: Rhinotomy is performed under general anesthesia to ensure that the patient is unconscious and pain-free during the surgery.
2. Incision: The surgeon makes an incision on the nose. The location and size of the incision depend on the particular case. It could be inside the nasal cavity or on the external part of the nose.
3. Surgical intervention: Through the incision, the surgeon accesses the nasal structures that need to be treated. This may involve removing tissue, correcting deformities, or reconstructing parts of the nose.
4. Closure: The incision is then closed with sutures, and if necessary, packing is placed inside the nose to support the new structure and control bleeding.

Recovery

Post-operative care is crucial for a successful recovery from rhinotomy. Patients may experience swelling, bruising, and discomfort around the nose, which can be managed with medication. It is important to follow the surgeon's instructions regarding nasal packing, which is usually removed a few days after the surgery. Patients are also advised to avoid strenuous activities and to keep their head elevated to reduce swelling.

Risks and Complications

As with any surgical procedure, rhinotomy carries risks and potential complications. These may include:

• Infection
• Excessive bleeding
• Adverse reactions to anesthesia
• Nasal septal perforation
• Changes in the sense of smell
• Unsatisfactory cosmetic outcome

Patients should discuss these risks with their surgeon prior to the procedure to make an informed decision about undergoing rhinotomy.

Conclusion

Rhinotomy is a significant surgical procedure that can offer relief and improve quality of life for patients with certain nasal conditions that are not amenable to less invasive treatments. As with any surgery, it is important for patients to understand the potential risks and to have realistic expectations about the outcomes.