# Nasal septal reconstruction Help ENT



## RSnodgrass (Oct 13, 2010)

Fellow coders:  See if you can help me out with this one...

Procedure: Nasal septal reconstruction and columellar reconstruction with chonchal cartilage from the right ear.

Incision was created through the skin overlying the chonchal cartilage.  The caudal elevator was used to elevate superficially to the cartilage.  Then, a circular shaped graft was harvested by undermining this carilage and removing it from the chonchal area.  When this had been completed, hemastasis was obtained with bipolar electrocauter.  The skin incision was closed with suture.

Following this, examination of the nose revealed marked retracted ofthe columella at the nasal tip, practically touched the upper lip.  The patient revealed no significant cartilage in the columellar for appox 1.5 cm.  At that point, the septal cartilage began, and there was present appox a 2cm strut of cartilage supporting the dorsum of the nose before there was a very large septal perforation present.  Thus the columellar and septal were inj wiht xylocaine and epinephrine.  After waiting appox five min, a hemitransfixion inc was created on teh left hand side, and a pocket was created in the anterior septum in the solumella with sharp scissors.  There were fragements of cartilage present but none that were giving any significant support.  The dissection was carried out to create a large pocket, which extended dow to the nasal spine, back to the leading edge of the existing cartilage and up into the nasal tip.  The conchal cartilage was then cut to a piece that would fit in this pocket and give support in this area.  It was secured wiht sutures to the leading edge of the septal cartilage as well as the anterior nasal spine.  After this was put in place, one more small piece of cartilage was placed up into the nasal tip and secured with suture.  the hemitrnsfixion suture was then closed.  

30620
30520
21235



Anyone want to help me out?  See what you come up with.


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## BCrandall (Oct 13, 2010)

21235 is fine, but 30520 is a CCI edit with 30620.


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