This remarkable woman led a challenging life, marked by experiences with domestic violence and a history of intranasal drug use. These hardships took a devastating toll on her nose, leading to a near-total septal perforation and a significant saddle nose deformity. Despite her challenges, she exhibited remarkable courage by choosing to regain control of her life.
Our Surgical Approach:
We harvested rib cartilage to rebuild her L-strut, utilizing large spreader grafts and an ASR graft secured to the nasal bones and nasal spine, respectively. It was a delicate balancing act to ensure adequate mucosal coverage with the barely remaining septal mucosa.
The remaining rib was used to create a diced cartilage construct, held together with Tisseel. This construct was thoughtfully overlaid to refine and smoothen her newly reconstructed dorsum.
Scarring within the nasal soft tissue envelope was released in an effort to derotate her nose. Years of repeated trauma and scarring had caused it to become significantly upturned and shortened.
Endoscopically, we lysed significant intranasal scar tissue, which was surprisingly obstructed despite the absence of a septum, to facilitate the opening of her nasal airway.
Results: This case was an exceptional challenge, and while perfection can be elusive in such intricate surgeries, what truly counts is the life-altering change we brought to our patients. She not only embraced her new appearance but, most importantly, experienced a profound enhancement in her nasal breathing and quality of life.
Photos: These images capture her progress at 3 months post-op, with some residual swelling still present.
(Nov 23, 2023)