# 30465 vs 30410?



## martnel (Jan 7, 2014)

Or something else, maybe?  This is a Humana patient....  I would very much appreciate any help with this one:  

OPERATIVE PROCEDURE:			
Open rhinoplasty with ear cartilage septal strut of septum, dorsal hump reduction, and tip refinement with thinning of lower lateral cartilages.

INDICATIONS:  This is a 31-year-old lady who had undergone a previous septal submucous resection for septal deviation with obstruction of airflow.  She was noted to have a depressed area along the right upper lateral cartilage and also a dorsal hump.  She desired to undergo dorsal hump reduction as well as correction of this lack of fullness along her right upper lateral site and some mild tip refinement.  I discussed with the patient the procedure of using an ear cartilage graft as she had already had a submucous resection.

DESCRIPTION OF PROCEDURE:  ...............A columellar incision was then made using a 15 blade in a stair-step fashion and opening of the nasal tip was performed using tenotomy scissors, opening up just below the lower lateral cartilages.  Following elevation of the skin and adipose tissue off of the cartilaginous structures, there was noted to be a dorsal hump which was shaved down along the septum superiorly and a rasp was also used to perform bony dorsal hump reduction.  Elevation of the lower lateral cartilages off of the septum was performed with tenotomy scissors and a Freer was used to develop a submucoperiosteal plane along the dorsal septum.

At this time, a posterior auricular incision was performed and dissection of the conchal bowl cartilage was performed using a 15 blade with care not to injure the anterior skin.  Following removal of the conchal bowl cartilage which measured approximately 1 cm x 2 cm, the skin was closed was closed using a running chromic suture and a bolster was placed using Xeroform and chromic suture.

At this time, the cartilage was contoured in order to allow for straightening of the septum.  This was tacked to the septum along the right lateral side of the dorsal septum using 5-0 Prolene sutures.  Trimming of the lower lateral cartilages was performed again using tenotomy scissors.  The lower lateral cartilages were then tacked back over the septum using interrupted 5-0 Prolene suture.  The intra-domal sutures were then placed in order to get appropriate tip refinements tip and the columellar cartilages were also sutured together with 5-0 Prolene suture.

The skin was then draped back over the cartilaginous structures where there was noted to be excellent overall contour.  At this time, the intranasal closure was performed using 5-0 chromic sutures and the skin edges were approximated using 6-0 Prolene sutures.  Bacitracin ointment was placed over the columellar incision and Steri-Strips were placed over the nasal dorsum to try to help prevent swelling.  A drip pad was placed as well.


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## martnel (Apr 18, 2014)

Does anybody have any advice here?  We are still debating and struggling with this one...


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