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Home » Table of Contents » Rhinoplasty Special Topics » Case Explication

Case Explication

by Sam P. Most, MD and Charles R. Woodard, MD on 09/27/2011

Sam P. Most, MD

Associate Professor & Chief
Division of Facial Plastic and Reconstructive Surgery
Stanford University School of Medicine
801 Welch Road
Stanford, CA 94305
smost@ohns.stanford.edu
Phone: 650-725-5950

Charles R. Woodard, MD

Clinical Instructor
Division of Facial Plastic and Reconstructive Surgery
Stanford University School of Medicine
801 Welch Road
Stanford, CA 94305
cwoodard@ohns.stanford.edu
Phone: 650-725-6640

Program Director and Associate Professor
Head and Neck Surgery & Communication Sciences
Duke University Medical Center.
Phone: 919-629-9821

Chief Complaint
Nasal obstruction and nasal deformity

History of Present Illness
30 year old female presented to the office with complaints of long-standing right > left nasal obstruction. There were no alleviating or aggravating factors. She denied nasal trauma or a history of nasal surgery. Additionally, she had aesthetic concerns regarding her nose. She wanted reduction of the dorsum and elevation of her tip.

Analysis of Photographs

Frontal View

Frontal View:
Proportional horizontal thirds and vertical fifths
Mild dorsal deviation to the right in the middle third
Relatively wide lower third
Irregular brow-tip aesthetic line due to midvault deviation
Symmetric, slightly widened tip defining points
Right alar base more cephalically oriented

Lateral Views 1
Lateral Views 2

Lateral Views:
Radix position adequate
Slight chin underprojection
Excessive dorsal height with dorsal hump
Tip underrotated
(Palpation revealed poor tip support)

Base View 1

With Inspiration

Base View 2

Base View:
Lateral nasal sidewall insufficiency with right external valve collapse
Shortened medial crura
Slightly widened domes
Wide alar base

Intranasal Exam:
Broad based septal deviation to the right
Lateral wall insufficiency with collapse of bilateral internal valves (right > left)
Bilateral inferior turbinate hypertrophy

Operative Plan:
Elevate septal flaps
Submucous resection of the inferior turbinates
Open rhinoplasty approach
Septal upper lateral cartilages from the septum
Rasp dorsum
Dorsal cartilaginous reduction
Medial and lateral osteotomies to close open roof
Upper lateral turn in flaps used as bilateral autospreader grafts
Septoplasty
Cephalic trim
Caudal extension graft
Tongue in groove setback of medial crura
Tip graft
Alar base excisions

Intraoperative Photo

Intraoperative Photo

Note the severely atrophic medial crura

Note the severely atrophic medial crura

9 Month Post-Operative Photos

9 Month Post-Operative Photos 1
9 Month Post-Operative Photos 2
9 Month Post-Operative Photos 3
9 Month Post-Operative Photos 4

Filed Under: Rhinoplasty Special Topics Tagged With: nasal deformity, nasal obstruction, Ptotic Tip, Reconstructive Surgery, USA

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