In nasal airway surgery, it is a great compliment when involuntarily the patient closes her mouth and breathes through her nose in the post operative photograph.
One of the more interesting observations in my patients is the ancillary findings on physical examination. Usually, I appreciate an unintentional open mouth smile in my post-operative photographs. However, for airway reconstructions, I am most pleased when the mouth is involuntarily closed. In these cases, I am convinced that the nasal airway is patent and the airway surgerywas successful.
At this point in my career, I have found that an optimal view of a deviated septum and it's correction with spreader grafts is best obtained via an open rhinoplasty incision. This approach allows separation of the lower lateral cartilages, visualization of the entire septum, and an optimal view through which to perform septoplasty. The harvested septum is then used for spreader grafts to support the internal nasal valve. I have been very happy with the use of septal cartilage for lateral crural strut grafs to stabilize the external nasal valve.
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