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PROFILES Modern Rhinoplasty Textbook

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Vestibular Stenosis

Written by Dr. Litner and Dr. Solieman

Another related but distinct phenomenon to valve collapse is the occurrence of vestibular stenosis. The nasal vestibule is the region of the nose within the nostril, just in front of the internal valve. Previous surgery can cause webs, abnormal bridges or connections of scarred skin or mucosa (lining tissue) to form between the septum and the nasal sidewall or turbinates, and may narrow the valve through scar contracture. This scar tissue can narrow the nasal passageway and cause significant troubles with regular breathing.

Vestibular stenosis is categorized by degrees of severity, ranging from Grade I (mild) to Grade IV (most severe). Surgical correction of this problem can be one of the most difficult problems faced by a rhinoplasty surgeon. Because of the complexity and sensitivity of the problems caused by vestibular stenosis, the preferred solution is outright prevention of any visible scarring in the initial procedure.

At Profiles, great care is taken throughout your procedure, including the design, execution, and meticulous closure of incisions in order to ensure that tissues are optimally aligned, tissue trauma is minimized, and scar tissue is not encouraged to form to any significant degree.

If a significant amount of scar tissue has formed though from previous surgery elsewhere, revision rhinoplasty may be necessary to improve scarring and to prevent the existing scar tissue from obstructing the nasal valve and altering the airflow. After the initial procedure, it may be necessary to wait six to nine months before another surgery can be performed, because the nose will continue to change as it heals. It is absolutely necessary to wait until the changes are complete before attempting a second procedure. The techniques used for a revision rhinoplasty are generally the same as for an initial rhinoplasty, though the open technique is generally preferred due to the more complex nature of revision rhinoplasty, especially in regards to vestibular stenosis.

Male face Before Septal Perforation treatment, front viewMale face After Septal Perforation treatment, front viewBeforeAfter
Male face Before Septal Perforation treatment, right side viewMale face After Septal Perforation treatment, right side viewBeforeAfter

In less severe cases, surgical correction may involve a simple release of synechia (scar band), with placement of nasal splints for a short time after surgery (a thin plastic spacer that allows healing of the tissues without reformation of the scar band). The synechia release can also be augmented with placement of skin, mucosal, or cartilage grafts as necessary, to maintain the structural integrity of the nasal passages. Because reduction rhinoplasty can often compromise the resilience of cartilage, such support grafts are often necessary in a revision situation. In more severe cases though, more complicated surgical procedures are available, such as intranasal Z-plasty (rearrangement of tissues) or composite grafting, with possible repeat surgeries to correct the scarring.


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