Oops... submitted without actually posting the op report!!
As a result of a fall in 2008 when her noes was fractures indicates an obvious deviation of the septum to the right airway. patient has a history of sinus problems since the fracture and wil be having the septum straightened, addressing the epistaxs by means of straightening the setpum, as well as revision of some of the hypertrophic turbinates.
The patient first had a killian incision made, and an open rhinoplasty incision so that the entire nasal cartilage could be visualized and then treated directly. The defect of the setpum into the right airway was addressed by using a ballenger knife resecting the excessive cartilage and then in situ fracturing the septum with arubin morselizer. the patient had both inferior turbinates reduced approximately 50% with cauterization of the medial sinus walls. The patient then required straightening of the nasal dorsum. This was done using a 3mm chisel infracturing the nasal bones. With the nasal pyramid secure, the patient then had the internal nasal valve managed. The internal nasal valve at the junction of the external nasal valve had obvious collapse and it was clear that if there was not support in this area securing the medial cvus to a supporting mechanism, the patient would not breathe. consequently from the right ear a 4cm x 1cm cartilage graft was obtained. this was sewn upon itself as a strut, and then the strut was placed between the mucoperichondrial flaps, secured to the base of the nose, and then after tightening the medial crural footplates with through and through sutures of 3-0 chromic, the patient had the lower lateral whole medial crus secured onto the dome of the strut with multiple sutures. The airways at this point were patent and there was good structural support to the tip. The patient at this point then had the mucoperichondrial flap secured back in position, the slight shortnening done at the distal crural septum, and the transdermal incsion closed with 7-0 nylon and with 5-0 chromic.
thanks