DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Post-traumatic nasal deformity with nasal septal deviation and airway obstruction.
POSTOPERATIVE DIAGNOSIS: Post-traumatic nasal deformity with nasal septal deviation and airway obstruction.
PROCEDURE: Open septal rhinoplasty.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General anesthesia.
ESTIMATED BLOOD LOSS: Nil.
COMPLICATIONS: None apparent.
DISPOSITION: To recovery in stable condition.
BRIEF CLINICAL HISTORY: The patient was approximately 1 year following a complex nasal facial injury. She had significant nasal airway obstruction on the left and obvious complex deviation of her nasal septum with distorting external scars. Therefore, after careful explanation of risks, benefits and alternatives, she agreed to an open septal rhinoplasty to relieve nasal airway obstruction and to do the best to our ability to restore better nasal structure.
DETAILS OF PROCEDURE: The patient was taken to the operating room and placed in the supine position for open septal rhinoplasty. General anesthetic was administered. She was orally intubated. Parenteral antibiotics were given. A full-face Betadine prep was performed and she was draped in a sterile manner.
A modified approach to the septal rhinoplasty was obtained because of the complex nature of her nasal tip and septal anatomy and her old scars. We will use the old nasal tip scar and open this with a rim incision on the right side and connecting with the transcolumellar V.
The skin flap was meticulously elevated, and there was a small tethering point where there was a perforation of nasal dorsally where there is an old scar. We elected not to revise the nasal dorsal scar so as not to devascularize the nasal tip skin.
The flap was elevated, otherwise, uneventfully. A subperichondrial dissection was performed of the nasal septal deformity. There was a very significant nasal buccal and dislocation of the caudal septum in the vomerine groove. A wide release of this was performed, of the buccal area, was resected without destabilizing the nasal support. The caudal septum was relocated in the midline and secured with 4-0 PDS suture. The upper laterals were released and tailored to provide midline support of the septum.
She had a spur up over the nasal bone dorsally on her right side where the upper lateral cartilage had been dislocated. This spur was reduced and a small cartilage graft was used to support this area. The graft was placed after the septum was straightened.
The distorted lower laterals were adjusted and secured with a medial crural, interdomal sutures to restore a more symmetric relationship.
The skin was re-draped and closed with a significantly improved nasal airway on both sides and better tip symmetry. The closure was done with small chromic sutures in the lining and 6-0 nylon on the skin. Septal splints were placed. She was awakened and transported to recovery in stable condition at the end of the open septal rhinoplasty.
