DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Traumatic nasal septal deformity with nasal airway obstruction.
POSTOPERATIVE DIAGNOSIS: Traumatic nasal septal deformity with nasal airway obstruction.
OPERATIONS PERFORMED:
1. Revision nasal septal reconstruction.
2. Rhinoplasty with bony osteotomies.
3. Repair of deviated nasal septum.
4. Nasal endoscopy.
SURGEON: John Doe, MD
ANESTHESIA: General, supplemented with 1% Xylocaine with 1:50,000 adrenaline and 4% cocaine solution.
COMPLICATIONS: None.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and placed in the supine position on the operating table. General anesthesia was introduced via endotracheal intubation. Local anesthesia was infiltrated intranasally. Routine sterile draping was carried out.
The patient had been previously operated on approximately 3 years ago with an attempt to reconstruct the bony pyramid as well as a bony and cartilaginous septum. This gave the patient some improvement; however, he continued to have a marked deviation of not only the septum, but of the entire bony and cartilaginous nose. He was, therefore, desirous of having further reconstruction and a revision of the previously performed surgery.
After adequate anesthesia was obtained, a bilateral nasal endoscopy was carried out using a 0-degree endoscope. Following this, a right hemitransfixion incision was made and mucoperichondrial flap was elevated off the left side of the septal cartilage and in addition mucoperiosteal flaps were elevated off the adjacent ethmoid and vomer bones. This was performed with a great deal of difficulty because of the scar tissue encountered as a result of the previous surgery and old trauma. The septal cartilage was freed up anteriorly and inferiorly.
Following this, bilateral intercartilaginous incisions were made and the skin was elevated off the dorsum of the nose. The bony pyramid was identified and the nasal bones had been fractured previously and had healed in an asymmetric and displaced fashion. There was also a significant amount of calcium encountered adjacent to the nasal bones secondary to previous surgery. Medial osteotomies were performed using a 6 mm unguarded chisel and lateral osteotomies were done with curved single guarded Neivert osteotomes. It was necessary to perform stepped lateral osteotomies on the left side in order to mobilize the nasal pyramid towards the midline. The upper lateral cartilages had been disarticulated from the nasal bones, most likely either due to the old trauma or previous surgery. An attempt was made to mobilize the upper lateral cartilages so that they could be replaced in a more anatomical position. The septum was then fractured towards the midline using a heavy elevator in the left nasal cavity. These procedures seemed to improve the previously described asymmetry of the nose as well as the deviated nasal septum.
The hemitransfixion incision was then closed with 4-0 chromic catgut interrupted sutures. Half-inch Vaseline gauze packing was placed in the left nasal cavity. Benzoin, 1/2-inch paper taper and plaster of Paris splint was applied to the dorsum of the nose. A mustache dressing was placed underneath the nose, and the patient was sent to the recovery room in stable condition.
