The Cottle Push down Operation

Abstract

The “push down” operation was developed by Maurice H. Cottle, M.D., of Chicago. This operation was developed as a more physiologic approach to the management of hump noses. This operation grew out of Dr. Cottle's observation of nasal trauma and his expertise with the handling of nasal septum deformities. He realized that there was a particular degree of support to the nasal dorsum given by the cartilaginous septum. Traditional hump removal, which involves amputation of the roof of the nasal dorsum, has serious physiologic and anatomical sequelae that are avoided using the push down operation. The push down operation not only lowers the dorsum of the nose, but also eliminates prominent bony humps. This effect is due to the flexibility of the chondro-osseous joint between the nasal bones and the cartilaginous vault. This area is known as the “K” area or keystone area. This is where the septum, upper lateral cartilages, and nasal bones join. This junction provides a hinge-like action, allowing for straightening of the dorsum and hump reduction. When performing the push down operation, the operating surgeon must have a thorough knowledge of septum, pyramid, and tip anatomy. The key to the push down operation is the septum, and thorough knowledge of its normal and abnormal anatomy is imperative.