# Rhinoplasty w/lateral osteotomies



## karilynn (Oct 4, 2013)

I am looking for help with a procedure that one of my physicians does. It is an Open Rhinoplasty with lateral osteotomies. He wants to use 30435 Rhinoplasty, secondary; intermediate revision (bony work with osteotomies) but his procedure is not secondary. The patient has not had any previous rhinoplasties. I am wondering if 30410 Rhinoplasty, primary; complete, external parts including bony pyramid, lateral and alar cartilages, and/or elevation of nasal tip would work instead. He is also doing an internal valve spreader graft (30465) but if I use the 30410, I believe that is included in the code. 

SURGERY:
1.  Open rhinoplasty with lateral osteotomies.
2.  Bilateral internal valve spreader graft.

PROCEDURE:  Prior to the surgery, patient had markings made in upright position in holding area, planning position of the internal valve spreader grafts as well as columellar incision.  After that, she is taken to the surgical suite and prepped and draped in the usual sterile fashion, injected by Dr#2.  15 blade used to make columellar incision that was carrying in transfixion and marginal.  Fine curved scissors are used to elevate skin flaps away from the medial and lateral crura of the lower lateral cartilages.  Access to the dorsum was obtained and dissected away.  After that, interdomal ligament severed, access to the septum obtained, and case turned over to Dr#2.

_(Dr. #2 does Septoplasty at this time)_

Out of material Dr#2 took out of septum, 2 internal valve spreader grafts were made approximately 16 x 2 x 2 mm.  They are placed in the subperichondrial pocket in internal valve.  Secured in place with 5-0 PDS.  After that, 12 mm straight osteotome used to remove the dorsal hump and with that, beaver tail rasp to smooth out minimal irregularity.  When that in place, piriform incision was made and low to high osteotomy subperiosteal canal made with Freer and then curved guarded osteotome used to do the osteotomy, right and left as well.  Infracture.  After that I had closure of the open roof deformity as well as straight pyramid.  Wound is irrigated and then skin flaps redraped, secured stitches with 5-0 fast absorbing gut on the columella, 3-0 chromic for intranasal incision.  Dr#2 placed intranasal splint and I placed Steri-Strips and Aquaphor splint for nose.  Extubated in room, transferred to recovery room in satisfactory condition.

Thanks for your help,

Kari


----------

