This patient is a 16 year-old male who presented with a history of nasal trauma 2 years ago, resulting in deformity of the nose. He did not seek medical attention at the time of the injury. As the swelling and bruising from the injury resolved, it became apparent that there was significant deformity of the structure of the nose. In addition, he noted persistent nasal obstruction, primarily affecting the left side of his nose. He was also having problems with recurring sinusitis. He tried medical treatment without improvement in his breathing. On exam, he was noted to have significant deformity of the nose with deviation of the bony and cartilaginous nasal dorsum to the left of midline and depression of the middle nasal vault with saddle nose deformity. He also had a bulbous, poorly defined nasal tip. In addition, there was marked deformity of the nasal septum and narrowing of the nasal valves that was causing significant obstruction of his nasal airways, worse on the left side. The deformity of the nasal septum was also contributing to the cosmetic deformity of the nose, because the caudal end of the septum was protruding into the left nasal airway, creating deformity of the columella and asymmetry of the nostrils. He underwent open septorhinoplasty in order to reconstruct the crooked nasal septum and the deformed bony and cartilaginous support structures of the nose, resulting in a more symmetric nasal dorsum, refinement of the tip, and improvement in the nasal airways.
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