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Stuck on this one . Patient had a release of vestibular stenosis bilaterally with local tissue rearrangement and a full thickness skin graft and removal of hardware. The dx was vestibular stenosis with impaired airway, status post total nasal reconstruction with radial forearm flap because of extensive squamous cell carcinoma . I looking at
here is op report
An incision was made across the base of the columella and across the edge of the nares where the forehead flap ha been sewn to the ling and the forehead flap was elevared up to the level of the tip .
This allowed acess to the anterior portion of the nose. There was a scar babd on the right, which was obstructing the airway and also some boggy tissue from the superior aspect of the narrow airway was collasping down to the airway. This was underminded bebneath the cartilage structure. There eas good bit of fat, which was retained in the area and the flap was then defatted.
Once the flap has been satisfactorily defatted, there was still narrowing of stenosis superirly and a full thickness skin graft was harvested from the right lateral brow area and pkaced into this deficiency. It was sewn in with the 5-0 Vicryl sutures. A single PDS suture was then used transmurally to fixate the skin back up to the lateral wall once the fat had been removed and 2 additional sutures were used. This seem TOopen up upper part of airway quite nicely and a Z -plasty was performed on the web in front portion of the nose and repaired with 5-0 sutures.
There was also a budle in the columella on the right side, which was a hardware, which was no longer needed and there was a long plarte, which was removed and a smaller olate, which was removed to the point where it was set into the area of the anterior nasal spine and would have b een in the mouth, so that left a small portion of the plate was left intact. The opposite site was then identifid and it was explored. Here there was a piece of projecting cartilage in the airway from thec old cartilage freamework, it was trimmed back. The lining flap on both sides was then cut back for about 4mm in order to allow for better movement of linning up into the apex of the nostril. The wounds were then closed w ith 5-0 Vicryl AND 2 stents were placed in nose.
Please help if can , so far I AM LOOKING AT 14060/ I KNOW THERE IS MORE , ANY SUGGESTIONS ?
here is op report
An incision was made across the base of the columella and across the edge of the nares where the forehead flap ha been sewn to the ling and the forehead flap was elevared up to the level of the tip .
This allowed acess to the anterior portion of the nose. There was a scar babd on the right, which was obstructing the airway and also some boggy tissue from the superior aspect of the narrow airway was collasping down to the airway. This was underminded bebneath the cartilage structure. There eas good bit of fat, which was retained in the area and the flap was then defatted.
Once the flap has been satisfactorily defatted, there was still narrowing of stenosis superirly and a full thickness skin graft was harvested from the right lateral brow area and pkaced into this deficiency. It was sewn in with the 5-0 Vicryl sutures. A single PDS suture was then used transmurally to fixate the skin back up to the lateral wall once the fat had been removed and 2 additional sutures were used. This seem TOopen up upper part of airway quite nicely and a Z -plasty was performed on the web in front portion of the nose and repaired with 5-0 sutures.
There was also a budle in the columella on the right side, which was a hardware, which was no longer needed and there was a long plarte, which was removed and a smaller olate, which was removed to the point where it was set into the area of the anterior nasal spine and would have b een in the mouth, so that left a small portion of the plate was left intact. The opposite site was then identifid and it was explored. Here there was a piece of projecting cartilage in the airway from thec old cartilage freamework, it was trimmed back. The lining flap on both sides was then cut back for about 4mm in order to allow for better movement of linning up into the apex of the nostril. The wounds were then closed w ith 5-0 Vicryl AND 2 stents were placed in nose.
Please help if can , so far I AM LOOKING AT 14060/ I KNOW THERE IS MORE , ANY SUGGESTIONS ?