Corrective Nasal Surgery in the Younger Patient

Authors: Eelam Adil Neerav Goyal Fred G Fedok

Publish Date: 2014/05/01

Volume: 16, Issue: 3, Pages: 176-182

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Abstract

A B and C Preoperative clinical photographs depicting flattening and widening of upper and middle nasal vaults secondary to comminution of nasal bones and fracture of cartilaginous septum resulting in left airway obstruction and acute saddle deformity D E and F Sixmonth postoperative clinical photographs after surgical repair involving septoplasty placement of bilateral spreader grafts lateral osteotomies and columellar strut The left ear served as a donor site for cartilage grafts A and D Frontal view B and E side view C and F base view G Intraoperative photograph showing severe septal displacement into the left airwayA B and C Preoperative clinical photographs depicting severe nasal deviation to the right and airway obstruction secondary to underlying septal deformity D E and F Eightmonth postoperative clinical photographs after surgical repair involving septoplasty placement of bilateral spreader grafts and lateral osteotomies A and D Frontal view B and E side view C and F base viewThe technique incorporates the use of spreader grafts to “brace” the septum in correct position A Superior view of deviated middle vault and septum B Upper lateral cartilages have been divided from septum in order to be able to divide septum vertically at the apex of the angulated region Although it is not always necessary to completely divide septum through its most superior portion in this depiction it is divided to allow maximal mobilization C Bilateral spreader grafts are sutured in place between upper lateral cartilages and septum The spreader grafts will hold the septal segments in correct position and reconstitute the middle vaultThis technique is based on the removal of a narrow strip of redundant or buckled cartilage parallel and adjacent to the maxillary crest to allow the repositioning of the cartilage back on top of the crest with minimal cartilage resection A Septal spur or buckling of the septum adjacent to the maxillary crest B A 15 scalpel is used to excise the narrow strip of redundant or buckled cartilage parallel to and adjacent to the maxillary crest C The septum is then repositioned over the maxillary crest If necessary the deviated maxillary crest bone may be carefully osteotomized to allow it to be fractured back into a vertical midline position without removal of boneDesign Setting and Participants  A retrospective medical chart review was performed for all male patients younger than 16 years and female patients younger than 14 years seen by the senior author FGF at a tertiary referral center between August 1996 and August 2012 The database was searched for patients who underwent septoplasty or corrective nasal surgery by the senior author

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