History
Mr AC is a 35 year old man who came to see Dr Robinson with severe nasal obstruction. He had broken his nose 2 times. After the first fracture he had had a septoplasty which worked well however he then fractured his nose again. He had trouble breathing through both sides of his nose and had noticed that his nose was significantly deviated to the left.
Mr AC came to see Dr Robinson with the goal of improving the breathing through his nose and if possible improve the appearance of his nose.
Pre operative assessment
Mr AC had a severe deviation of his nose in the mid third to the left. He had very little support in his nasal tip. There was also severe nasal valve collapse on inspiration and deviation of his septum to right anteriorly and the left posteriorly.
Intraoperative procedure
Mr AC had an external approach rhinoseptoplasty and turbinoplasty. The general steps of the operation were as follows:
- Because Mr AC had very little structural support in his nose Dr Robinson took a conchal cartilage graft from the left ear
- Combination osteotomies were used to refracture the nasal bones
- Nasal bones were mobilized to the midline
- An extended right spreader graft was placed to provide the required support to the mid third of the nose
- An external approach septoplasty was used to fix the septal deviation which was associated with the latest fracture.
- Lateral crural turn in flaps were performed on both lower lateral cartilages.
- Domal and interdomal sutures were used to redefine the nasal tip.
- A columella strut graft was used to provide additional support to the nasal tip.
- A bilateral turbinoplasty was performed endonasally utilizing endoscopic techniques.
- Crushed cartilage was used over the dorsum to provide additional contouring of the nose.
Post operatively
Mr AC had an uneventful post operative period and noticed an immediate improvement in the breathing through his nose. Mr AC was very happy with the result which was achieved from the surgery and this is reflected in his post operative evaluation questionnaires.
NOSE Questionnaire
This questionnaire evaluates breathing through the nose. The lower the number the better the breathing through the nose. Mr AC has gone from a significantly blocked to nose with a score of 14 to an excellent score of zero.
Rhinoplasty outcomes evaluation
This questionnaire is used to evaluate the cosmetic outcomes of a rhinoplasty. Mr AC has had a very signicant improvement on this questionnaire with a score going from 6 to the maximum score of 24.
