This 15 year old young lady had severely deviated nasal Cartilagenous septum that completely blocked her Right nasal airway. The bony septum was severely deviated to Left causing a Left nasal blockage. The Maxillary crest was positioned far towards the Right and the lower third of the nose in particular presented an asymmetrical structure. This lovely young lady who is an active athlete, was disadvantaged both Functionally and Cosmetically.
Traditionally, an attitude of restraint has been employed by most surgeons till an empirical age of 18 years. This is to avoid the possible adverse effects that the growth spurts may have on the nose and midface region. Some authors, however, have claimed a paucity of evidence that such untoward effects of surgery are frequent. Research has shown that surgical intervention limited to certain areas of the bony and cartilaginous nasal framework is less likely to affect natural growth patterns. There is a growing consensus toward early intervention, especially in a select group of patients, where deferring the surgery may turn out to be the poorer option in the short and the long term, and suggestions have been made that conservative guidelines may be employed to minimize the unwarranted results.
Reconstructed CT Scan of Nose & Paranasal Sinuses
3D Reconstructed CT Sinuses show the anatomy of bony septum and maxillary spine-crest
Anterior Rhinoscopy diagram in Clinic
CT Scan Of Nose & Paranasal Sinuses
Completely blocked Right nasal airway
Mostly blocked Left due to an Internal Valve Stenosis
Nasoendoscopy and Photo-documentation of the Airways
Understanding the external changes based on the infrastructure
IN-SITU “Extracorporeal Septoplasty” type steps were utilised to achieve this result.
To protect the identity patients eyes have been digitally morphed and area covered by text. Patient and mother have kindly consented to share these pictures on the blog as this particular case has several teaching messages for patients needing and surgeons offering Nose surgery at a young age.
Sometimes waiting for the pubertal mid-Facial growth spurts to finish around 18years is not the best option.
15 years old girl
Severely crooked nose
Severely blocked nose
Plan : Cosmetic & Functional Septo-Rhinoplasty
Because …
Deferring surgery here till she is about 18 years old would be the poor choice.
The chances of Revision surgery here are high as the mid-facial growth continues through the growth spurt
Improvement as reported by patient at four months after surgery
Breathing improved from 2/10 to 9/10
Appearance improved from 3/10 to 10/10
Received Invitation to Lecture at ESPO (European Society of Paediatric Otolaryngology, 2014 – Rhinoplasty in young patients)
