Diagnoses/es:

Nasal deformity with nasal obstruction and prominent Adam's apple.

Anesthesia used:

General.

Procedure name:

Septorhinoplasty, cautery to the turbinates and reduction of Adam's apple.

Description of procedure:

Under general with endotracheal intubation the patient was prepped and draped in the usual careful sterile manner. A horizontal incision was made above the thyroid cartilage and Adam's apple reduction was carried out as outlined in my article on the archives of facial plastic surgery. The subcutaneous tissues were dissected and the strap muscles were separated. The perichondrium of the thyroid cartilage was divided in a vertical manner and stripped of the thyroid cartilage. The midpoint of the cartilage was then drilled and a Keith needle was placed in the thyroid cartilage into the glottis. Direct laryngoscopy confirmed the level of the marker being approximately 2 mm above the vocal cords. This was the reference level for cutting the thyroid cartilage above it, which was carried out with Stricker saw. The soft tissues were then closed using 4-0 chromic catgut. The Penrose drain was inserted and subcutaneous closure with 4-0 chromic catgut was carried out with subcuticular closure using 4-0 Nylon suture. Attention was then directed to the nose where the inferior nasal turbinates were out fractured and cauterized. The grossly deformed nasal septum was corrected by a right hemi-transfixion incision removing the nasal crest of the maxilla, part of the vomer and perpendicular plate of the ethmoid, together with resection of part of the ventral margin of the septum. The alar cartilages were then divided. Cephalic borders were trimmed using complete rim technique and the lateral crural flap was used and the excised triangle area was sutured together with 5-0 nylon sutures. The medial crura was sutured together with 5-0 nylon suture as well. The domes were amputated prior to that maneuver taking approximately 5 mm on each side. The nasal dorsum was lowered particularly in the bony portion. Medial and lateral osteotomies were performed. All the incisions were closed using 4-0 chromic catgut. Bilateral nasal packing together with adhesive tape and plaster of Paris were used. He withstood the procedure well. His voice was checked postoperatively and it was excellent.