Intraoperative Details
Decongestion of the nasal mucosa with oxymetazoline, phenylephrine, allows adequate endonasal visualization. Injection of the nasal soft tissues with lidocaine and epinephrine allows adequate vasoconstriction and decreases intraoperative bleeding.
Augmentation performed via an open rhinoplasty approach. An open approach involves elevation of the skin and soft tissue envelope via a transcolumellar incision that is carried along the medial crura and the caudal aspect of the lower lateral cartilages. The entire cartilaginous skeleton of the lower and upper lateral cartilages should be exposed.
Dissection should proceed in a submuscular aponeurotic plane. Dissection superficial to this plane results in compromise of the vascular supply to the soft tissues and makes the dissection very difficult.
At the bony cartilaginous junction, the periosteum over the nasal bones is elevated and the dissection is carried in this plane up to the nasofrontal angle. The entire nasal skeleton should be adequately visualized.
Once the anatomy and the defects are adequately visualized harvesting of the rib cartilage was done. The rib is harvested through an incision along the chest wall to remove the cartilage portion of the rib, leaving behind the bony portion of the rib.
Grafts are fashioned and sculpted to the desired size and shape and are sutured in the desired location. The graft is secured in place with carefully placed, multiple 5-0 clear nylon.
Corrections are performed until the desired outcome is achieved. After augmentation is complete, the skin and soft tissue envelope are carefully red raped over the nasal skeleton and sutured in place with 6-0 nylon. An external nasal splint was performed.
pre- and post-operative finding:
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