Description

Operation: Primary Preservation Rhinoplasty, SPAR B Modified Cottle low strip technique, Septoplasty, Costal cartilage Graft, Right SEG, Crushed Cartilage Supratip, tip and left sidewall graft.

Indications:
Description of procedure:
Pre-operative diagnosis:
Aesthetic nasal concerns

Post-operative diagnosis:
Aesthetic nasal concerns

Procedure:
1. Primary preservation open septorhinoplasty
2. Costal cartilage grafting

Procedure:
The patient was brought to the operating room and identified by name and date of birth. Intravenous anesthesia was administered and an LMA was placed. The nose, pyriform and septum were infiltrated with 1% lidocaine with 1:100,000 epinephrine. The patient was prepped and draped in the standard sterile fashion.

An inverted V columellar incision and marginal incisions were marked out and incised. The soft tissue envelope was lifted off the cartilage and bony framework. The periosteum over the nasal bones was incised and elevated.

An incision was then made along the scroll region and the skin and soft tissue were elevated off the maxilla and nasal bones to prepare for osteotomies. The Piezo saw was then used to make low-low-high osteotomies as well as a horizontal osteotomy at the nasion. The dorsal roof remained intact. Small segments of nasal bone were removed at the pyriform aperture to allow for let down of the dorsal hump. This was done assymetrically with more taken of the right to adjust for axis deviation.

The medial crura were separated sharply. The anterior septal angle was identified. A left mucoperichondrial flap was elevated. Dissection proceeded anteriorly around the caudal end of the septum allowing elevation of a mucoperichondrial flap on the right. There was severe caudal septal deviation. We elected for a SPAR B technique.

A high wedge of cartilage and PPE were removed allowing for let down and we used the 2 mm osteotome to completed the transverse osteotomy. Next the inferior strip was removed This cartilage was twisted and deformed and did not allow for harvesting of graft material. Costal cartilage was prepared for grafting.