Specialist in CranioMaxillofacial Trauma,
Eutrapio S. Guevara Jr., MD, FPCS
Trust your face to a facial plastic surgeon with extensive experience
in reconstructive surgery.
Recent advance in the management of complex panfacial trauma enable accurate restoration of facial form and function. An organized, proper sequencing, yet flexible approach is required to achieve consistent anatomic reduction of fractures. Although the order of repair is not critical, results are optimized if central midfacial reduction and projection are prioritized after occlusion and stable adjacent buttresses have been established.
Fractures of Upper and Lower Jaw
Revision Surgery of Panfacial Fracture
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After
Craniomaxillofacial Fracture Reduction
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After
Craniofacial Fracture Reduction
Trauma to Lower Eye Lid
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After
The CROOKED NOSE
Definition:
Commonly used for all the clinical conditions involving the deviation of the nasal pyramid from the median line.
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Results:
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Blunt trauma from sports injuries (boxing, basketball eg. “nasiko, head-butting”)
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Road or vehicular accidents
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Bathroom slippage
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Strokes
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Child or birth delivery: Forceps-assisted or Breech delivery, etc or other form of accidents hitting the nose
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Congenital: Craniofacial deformities e. Complete cleft lip & palate, Hemifacial deformities; development-failure of the nasal septum to develop normally
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Consequences:
A. Functionality – nasal obstruction, great difficulty in nasal respiration
B. Esthetic term - the nose is the most prominent and the center of attraction of the human face ( unsightliness that cannot be hidden)
“The face plays the crucial role in social relations as it is the first thing people seen upon meeting.”
Goals:​
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Harmonious/balanced facial appearance (Aesthetics)
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Longevity of results
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Preservation/improvement of nasal airway (Functions)
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After
Nasal Obstruction in Deviated Nose Patients
The foremost and most common cause of nasal obstruction among deviated nose patients is the deviation of the nasal septum. There are diverse forms of nasal septal deviations, including caudal deviation, dorsal deviation, Mid-segment deviation, and bony deviation. Thus, the treatment must be varied according to the individual characteristic of each form.
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“70 - 80% of traumatic crooked nose has septal deviation”
Crooked Nose: An update of management strategies, Wael K. A. Hussein, Egyptian Journal of Ear, Nose & Throat allied Sciences, Vol 16, Issue 1, March 2015, pp. 1-7
Diagnostic Procedures
A. Physical Examination: note for nasal dorsal deviation, asymmetry of the nostril and columella
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B. Nasal Endoscopy
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C. CT-SCAN of the nasal bone, Paranasal Sinuses with 3-D Reconstruction
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Surgical Treatment of Crooked Nose
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Close Reduction
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Reduction relies on the mobility of the fractured bony segment and must be performed before rigid osseous union has occurred (1-3 days)
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Vigorous digital pressure will re-fracture the bones and allow movement of the bony nasal vault
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The cause of inadequate bony vault mobilization is a high bony septal deviation that impedes nasal bone movement.
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The bony septum must be returned to midline. If there is already solid bony union, perform an open reduction with controlled osteotomies.
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Open Reduction - Open Structured Septorhinoplasty
Correction of Dislocation of the Posteridor Angle of the Septum from the Anterior Nasal Spine (Deviated Caudal Septum)
Inferior tunneling of the opposite side
Running quilting suture technique and silastic sheet fixation technique
S-Shaped Traumatic Deviation of the Nose Corrected by Splinting or Scoring with spreader graft
Severe Traumatic S-Shaped deviation of the nose.
Intraoperative Open Septorhinoplasty technique with Dorsal Septal Deviation and Caudal Dislocation.
Correction done using Unilateral/Bilateral Septal and Caudal Septal Extension graft to splint the nose.
Few months postoperative correction of the crooked nose.
