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PREOPERATIVE DIAGNOSIS:
- Nasal obstruction secondary to deviated septum, hypertrophic turbinates, and external/internal valve collapse s/p rhinoplasty.
- Hypertrophic turbinates, deviated septum.
PROCEDURE:
- Septal reconstruction for correction of deviated nasal septum and harvest of septal graft.
- Repair of nasal vestibular stenosis with reconstruction of external valve collapse with placement of bilateral alar batten grafts.
- Repair of nasal vestibular stenosis with reconstruction of tip support with placement of columellar strut.
- Repair of nasal vestibular stenosis with reconstruction of internal valve collapse with placement of bilateral spreader grafts.
- Repair of nasal vestibular stenosis with reconstruction of external valve collapse with placement of bilateral alar batten grafts
- Right deep temporalis fascia harvest.
- Bilateral Turbinoplasty.
- Bilateral osteotomies of twisted nasal bones causing nasal inlet obstruction.
Secondary Rhinoplasty with dorsal augmentation, platelet gel application
FINDINGS: Left septal spur and deviated bone and cartilage, Absent lateral crura bilaterally (intermediate, dome and medial crural present) with bilateral bossa (left greater than right), narrow middle vault, over-projected tip, collapsed right greater than left external valve collapse, radix and cephalad dorsum over-resected, 3+ skin scarred/adhesed to nasal tip and middle vault.
COMMENT: Nose continues to improve. Patient has experienced improved breathing and a softer nasal appearance.
