Journal of ISSN: 2379-6359 JOENTR

Otolaryngology-ENT Research
Case Report
Volume 6 Issue 6 - 2017
Case Report: Revision of a Nasal Scar after a Vehicle Accident
Menwal Harb*
ENT Specialist, American Crescent Health Care Center, UAE
Received: November 26, 2016 | Published: April 21, 2017
*Corresponding author: Menwal Harb, ENT Specialist, Arab Board Certified, Syria American Crescent Health Care Center, Abu Dhabi, UAE, Tel: 00971528046377; Email:
Citation: Harb M (2017) Case Report: Revision of a Nasal Scar after a Vehicle Accident. J Otolaryngol ENT Res 6(6): 00187. DOI: 10.15406/joentr.2017.06.00187

Abstract

A 30 years old male patient presented with a nasal scar at the junction between the columella and the nasal tip, after one year of exposure to a vehicle accident with an inappropriate suturing, I found that the scar repositioning is the best technique for this patient, so I decided to do external approach Rhinoplasty with changing the position of the new scar to a lower position.

Keywords: Scar revision; External approach rhinoplasty; Facial wounds

Introduction

The healing of the wound results in a scar, the appearance of the scar depends on the wounding mechanism, wound location, wound tension, initial treatment, infection, and dehiscence [1]. Successful scar revision begins with a precise analysis of both the scar and the patient expectations. The surgeon should educate the patient on the true realistic goal of surgery, which is to modify the scar to a point of maximized camouflage within the natural shadows, lines and borders that exist within the head and neck [2].

Case Presentation

A 30 years old male patient presented with a nasal scar at the junction between the columella and nasal tip at the left side of the nose, after one year of a vehicle accident, with a left side nasal obstruction.
No other complaints, no medical history, no surgical history.

The physical examination

An external nasal scar, deviation of the nasal axis to the right side, left septal deviation, the remainder examination is within normal. The goal is to remove the scar and improve the nasal breathing.

The plan

 External approach rhinoplasty, which is discussed with the patient and greed.

The surgical technique

The first step is the scar removal, after that I completed the surgery as a traditional external approach rhinoplasty with septoplaty, hump grasping, bilateral lateral osteotomies, tip plasty, then I retracted the nasal skin and stitched it at the columella at the lowest possible position without any tension at the sutures and wound edges, which was at the middle of the columellar length, then I trimmed the skin edges to create the nostrils edges. The result and follow up: The stitches and the nasal splint are removed one week after the surgery, and the patient returned to his normal daily activities after two weeks. The follow up after six months: The patient is fully satisfied of the result, functionally and aesthetically, (Figure 1). The techniques of scar revision are classified in (Table 1).

Figure 1: The patient before and after the surgery.

Excisional Techniques

Incision Placement

Fusiform Excision

Shave Excision

Scar Repositioning

Serial Partial Excision

Irregularization Techniques

Z-plasty

W-plasty

Geometric Broken-line Closure

Dermabrasion, Laser Resurfacing

Fillers

Adjunctive Techniques

Steroids

Dressings, Medications

Cosmetics

Table 1: The techniques of scar revision [2].

Discussion

Causes of unfavorable scar formation can be genetic, iatrogenic, circumstantial, or idiopathic [3]. In our case I chose the scar repositioning technique, and discussed with the patient, that I will do an external approach rhinoplasty to extend the skin and make the scar in a lower position without any unnecessary skin incisions, and to correct the nasal axis deviation and the septal deviation.

Conclusion

The best technique of scar revision is the technique that gives us the best camouflage, by doing the incisions parallel to or in relaxed skin tension lines, at the junction of facial aesthetic units, within margins of orifices, or at the edge of hair line, and staged procedures are often necessary to accomplish the optimal result.

References

  1. Bailey Byron J, Johnson Jonas T, Shawn Newlands D (2006) Head & Neck Surgery-Otolaryngology. (4th edn), California, USA.
  2. Paul Flint W, Bruce Haughey H, Valerie Lund J, John Niparko K, Mark Richardson A, et al. (2011) Cummings Otolaryngology-Head & Neck Surgery, (5th edn).
  3. Garg S, Dahiya N, Gupta S (2001) Surgical scar revision: an overview. J Cutan Aesthet Surg 7(1): 3-13.
© 2014-2017 MedCrave Group, All rights reserved. No part of this content may be reproduced or transmitted in any form or by any means as per the standard guidelines of fair use.
Creative Commons License Open Access by MedCrave Group is licensed under a Creative Commons Attribution 4.0 International License.
Based on a work at http://medcraveonline.com
Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version | Opera |Privacy Policy