PREOPERATIVE DIAGNOSIS:
- Nasal obstruction secondary to external/internal valve collapse, residual deviated septum (ICD-9 Code 478.19) following rhinoplasty.
- Residual deviated septum.
PROCEDURE:
- Repair of nasal vestibular stenosis with reconstruction of external valve collapse with placement of bilateral lateral crural strut 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 shortened, over-rotated caudal septum with placement of bilateral septal extension graft.
- Repair of nasal vestibular stenosis with reconstruction of bilateral rim external valve collapse with placement of bilateral composite grafts.
- Revision Septoplasty.
- Repair of nasal vestibular stenosis with reconstruction of C-shaped septal deformity with placement of a septal batten graft.
Tertiary Septorhinoplasty, platelet gel application.
OTHER PROCEDURES: Chin Implant.
FINDINGS: Narrow left greater than right external valve and rim; Grafts harvested from rib, right greater than left alar retraction, narrow middle vault, C-shaped deformity with caudal septum deviated to right and to the left posteriorly. Over-rotated/shortened tip; thin, narrow, asymmetric, weak, buckled lower lateral cartilage (LLC), collapsed LLC left greater than right; over-resected caudal septum; convex right nasal bone, tight skin envelope and cartilaginous pollybeak.
COMMENT: The 4 month post-op photos reveal an improved and functional nose. The nose will continue to heal.
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