The Open Approach

The open approach is not a different surgical technique, but only a different surgical approach to the nasal septum or pyramid with respect to the classic endonasal approach. A nasal surgeon should be a master of both approaches. There are no dogmatic indications for either and the surgeon must decide on the basis of personal experience which would be better for the patient in question. The open approach offers some important advantages.

First of all, it eliminates the need to imagine the osteocartilaginous nasal structure, all of which can be exposed with no tension or distortion so as to arrive at a precise diagnosis of the factors responsible for nasal deformity. The rest of the team can also contribute actively to the operating surgeon’s decisions as happens in the traditional surgery of other areas.

It also makes it possible to place grafts easily even in areas that are almost inaccessible with the closed approach, which ensures lasting stability. At the same time, it should be stressed that the open approach is no more traumatic for the patient. On the contrary, bleeding can be monitored more precisely under direct visual control and no further incisions are required inside the nose.

The open approach encapsulates the modern concept of rhinoplasty, no longer designed to cut and remove structures but to rebuild and reshape while preserving the osseous and cartilaginous elements already present.

What is new today is the pursuit of perfect results without radically altering and hence weakening the anatomy of the structures involved. Thanks to a difference in approach, open rhinoplasty allowa a series of surgical procedures and concepts that can, in some cases, enhance the precision and predictability of the end result.

Atraumatic Rhinoplasty

While a great deal has been said about the surgical techniques used to obtain the best functional and aesthetic results in the field of septorhinoplasty, equal attention has not been focused on the postoperative period and the techniques that can make it as atraumatic as possible.

The progress in nasal surgery over the last few years has been linked to the improvement not only of techniques but also of postoperative care.

Patients who undergo septorhinoplasty often complain about terrible problems in the immediate postoperative period, largely connected to the use of highly traumatic techniques. The most significant of these appear to be pain, bruising, hematomas, oedema, bleeding, lacrimation, and blocked nasal respiration. All this can scare patients to the point where they decide to forgo the operation or are unable to face it with the necessary calm.

The postoperative period of septorhinoplasty can instead prove nontraumatic and the patient can present a pleasant and socially acceptable appearance even on the day after. Attainment of this objective depends on the use of some intraoperative procedures designed to make the operation as “soft” as possible.

At the same time, while the open approach may seem more aggressive, in actual practice it involves fewer postoperative sequelae on the whole, probably as a result of improved control over bleeding and the absence of incisions inside the nose. Interruption of the internal mucosa disrupts the delicate vascular balance of arteriovenous and lymphatic drainage between the superficial and deeper anatomical areas, thus causing a thickening of the tissues that takes a very long time to disappear.

With a view to avoiding the traditional nasal packing, particular importance attaches to the execution of precise hemostasis, seeking out and blocking the points of most frequent bleeding. Internal and external suturing of all the incisions can also help to eliminate the need for packing except in particular cases.

The surgical protocol proposed for nontraumatic septorhinoplasty has proved particularly effective in ensuring an acceptable postoperative period essentially free from pain and problems. In actual fact, use of the above procedures makes it possible for patients to have a pleasant and presentable appearance even from the day after the operation.