Description

Surgery: 19 yo female who underwent a Primary Preservation Rhinoplasty, SPAR B Modified Cottle low strip technique, Septoplasty, Septal cartilage Graft, left SEG with right ANSA banner graft, Crushed Cartilage Supratip graft.

Indications: 19 yo female with Aesthetic nasal concerns and a caudal deviation of the septum and dorsal hump.

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
3. Inferior turbinate submucous reduction
4. Inferior turbinate outfracture.
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.

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. We elected for a SPAR B technique.

Next, the cartilaginous septum was dissociated from the PPE and bony septum. 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. Septal cartilage was prepared for grafting. The Septum was dissociated from the maxillary crest. The septum was advanced and counterclockwise rotated. A trough in the nasal spine was created and the septum was secured with 4-0 PDS suture allowing for adequate let down and straightening of the septum. Any redundant septal cartilage and deviated bony segments were resected.

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. A septal extension graft was fashioned from the prepared septal cartilage and secured to the maxillary crest and left side of the native septum with 4-0 PDS and 5-0 prolene. 5-0 prolene dome spanning and lateral crural tensioning sutures were placed to create new domes and increase rotation, securing the lower lateral cartilages to the septal extension graft. The skin was elevated off the medial crura. A right ANSA banner graft was secured to the septum and caudal septal extension graft. A tongue-and-groove procedure was performed and the medial crura were sutured to the caudal septum with 5-0 prolene. Medial crural fixation sutures were placed to secure the medial crura together and narrow the columella. Crushed cartilage was placed in the supra tip and tip and secured with 5-0 chromic suture.