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PREOPERATIVE DIAGNOSIS:
- Nasal obstruction secondary to external/internal valve collapse, residual deviated septum, following rhinoplasty.
- Residual Deviated septum
POSTOPERATIVE DIAGNOSIS: Same, with right intranasal synechiae and bilateral medialized inferior turbinates.
PROCEDURE:
- Repair of nasal vestibular stenosis with reconstruction of external valve collapse with placement of bilateral lateral crural strut grafts.
- Repair of nasal vestibular stenosis with reconstruction of internal valve collapse with placement of bilateral extended spreader grafts.
- Repair of nasal vestibular stenosis with reconstruction of shortened, over-rotated caudal septum with placement of a septal extension graft.
- Revision Septoplasty.Revision Septorhinoplasty (Secondary), bilateral inferior turbinate fracture; lysis of right intranasal synechiae and platelet gel application.
FINDINGS: Narrow right greater than left external valve; Grafts harvested from rib, narrow middle vault right greater than left, bony septum deviated to left and right cephalad anterior spur (impinging and attached to right middle turbinate), septal, L-strut in place, Subnasale implant removed in two pieces, over-rotated, short, over-projected nose; tip graft removed and reused; scar/soft tissue fullness over right lateral ala; malpositioned weak lower lateral cartilage approx. 5 mm (right wider/longer than left); narrow left lateral nasal wall; septal bone removed and cartilage strut in place; right cephalad anterior spur; over-resected dorsum; and over-resected anterior caudal septum.
COMMENT: Post operative photos reveal improved side and front profile, and a more symmetric nose. Patient has reported improved breathing as well.
