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PRESERVATION RHINOPLASTY Case 6

Gender
Female
Age
19

Description

Indications: 19 yo female who underwent Primary cosmetic preservation septorhinoplasty with septal cartilage grafting (right ANSA, crushed supratip and infratip graft)

Indications: Aesthetic nasal concerns

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

Post-operative diagnosis:
Aesthetic nasal concerns

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

Findings:
Primary cosmetic preservation septorhinoplasty with septal cartilage grafting (right ANSA, crushed supratip and infratip graft)

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 pyriform aperture 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.

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.

Next, a modified through and through dorsal cartilage z plasty incision was performed along with an osteotomy through the perpendicular plate of the ethmoid bone to allow for let down of the dorsal hump. At this point, the nasal dorsum was fully let down. A 5-0 prolene was placed around the excised septal cartilage segment to hold the let down dorsal hump in position. An inferior oblique incision is then carried caudally through to the anterior septal angle to level of cartilaginous dorsum.

Inferior septal cartilage was harvested in one piece with care taken to maintain greater than 1.5 cm L strut. The anterior left upper lateral cartilage was released from the septum. Cephalic trims were performed leaving 8mm wide lower lateral cartilages and releasing the scroll. An ANSA banner graft was fashioned from the harvested septal cartilage and secured to the maxillary crest and left side of the native septum with 4-0 PDS and 5-0 prolene