Secondary

Rhinoplasty post-trauma with major deviation. This patient sustained a significant trauma that worsened a deviation likely already present beforehand. In addition, the “skin envelope” is large, draped over an asymmetric osteocartilaginous framework that is itself excessively voluminous. The tip appears “drooping” and overly long due to structural weakness of the distal septum. Beyond the aesthetic deformity, there is substantial functional impairment, as clearly demonstrated on CT. Correcting such a condition requires intervening on every component of the nose, both bony and cartilaginous, by fully mobilizing the nasal bones, reconstructing the septum, and re-establishing symmetry of the cartilaginous structures of the dorsum and tip. Power tools and piezoelectric instruments are particularly important for the precise manipulation of the nasal bones. In this case, given the severity of septal deformity, it was also necessary to use a component harvested from the rib to provide stability and form to the new septum, which was reconstructed on the back table and repositioned in its anatomical location.

At one year postoperatively, the deviation is almost completely corrected, with only a slight residual right-sided convexity. The aesthetic lines of the dorsum are nonetheless satisfactory.

Reconstruction and stabilization of the septum result both in achieving median symmetry of the nasal pyramid and in centralizing the tip. The tip cartilages are reshaped and made symmetrical through the use of several thin cartilage grafts that, despite their size, serve an important structural function.

In the profile view, the tip is well supported. The dorsum is slightly convex, as appropriate for a male face.

Detailed superior views of the nasal pyramid aid in evaluating the degree of symmetry actually achieved.

The scar from the rib cartilage harvesting is present and barely visible, with minimal aesthetic impact.

The sagittal and coronal CT scans demonstrate the significant deviation of both the septum and the nasal bones. CT imaging is fundamental for Dr. Robotti in accurately planning the surgical steps required for these structures, indicating the exact locations and precise nature of the underlying problems.