Why the nasal bridge sinks and one side becomes blocked after rhinoplasty osteotomy: Internal nasal valve reconstruction and restoration

Hello, I am Dr. Peter C. Kang.

Today, I would like to share a restorative case of a patient who suffered from collapsed nasal bones and severe breathing difficulties due to excessive osteotomy in a prior surgery.

2 years ago

• Ear cartilage + septum + implant-free + dorsal hump reduction + osteotomy

Patient information

• Current medication: Immunosuppressant (Rinvoq)

• Allergies: Rhinitis, atopic dermatitis

• Concerns regarding facial atopic flare-ups from taping

Chief complaints

• Severe pain, pulling sensation, and tightness at the osteotomy site

• Pain radiating from the columella to the gums upon touching the nose

• Severe nasal obstruction resulting from the osteotomy

• Pain whenever force is applied to the columella

• Pain occurring even while washing the face

• A sensation of laxity or displacement in the columella

• Progressive depression and sinking of the nasal dorsum

Response from the previous clinic

• Advised that "nothing more could be done; if pain persists, total removal is the only option"

Detailed diagnostic findings

• Collapse of the nasal bone due to excessive osteotomy of the left nasal bone

• Left internal nasal valve stenosis caused by collapse of the nasal roof

• Suspected neuropathic pain at the left osteotomy site

• Compromised breathing function due to septal injury

• Persistent pain resulting from structural instability

• Osteotomy reversal/restoration (desired widening if breathing issues are present)

• Functional improvement as the top priority

• Accurate assessment of any septal damage

• Resolution of pain

Key focus: Osteotomy restoration and reconstruction

• Performance of restorative surgery on the over-osteotomized left nasal bone

• Restoration of the collapsed nasal roof to its normal height

• Structural correction to secure the airway passage

State where the left lateral osteotomy was overly aggressive, causing the bone to collapse inward

Internal nasal valve reconstruction

• Internal nasal valve reconstruction using autologous rib cartilage

• Resolution of stenosis caused by the collapsed nasal roof

• Elimination of the root cause of left nasal obstruction

State of left nasal valve stenosis

Upper lateral cartilage reconstruction

• Upper lateral cartilage reconstruction using autologous rib cartilage

• Reinforcement of the nasal roof supporting structure

• Securing long-term stability

Septal reconstruction

• Precise reconstruction of the damaged septum

• Stabilizing the central nasal axis

• Restoration of bilateral respiratory functional balance

Structural reconstruction

• Full reconstruction using autologous rib cartilage

• Stabilization of the unstable structure

• Elimination of the cause of neuropathic pain

• Improvement in breathing by elevating the nasal roof

Functional improvement

• Restoring respiratory function with septoplasty

• Resolution of structural issues caused by excessive osteotomy

• Securing the airway passage through nasal roof reconstruction

Special considerations

• Careful management of the healing process due to immunosuppressant use

• Surgical and recovery planning tailored to atopic dermatitis

Structural restoration

• Repositioning of the collapsed left nasal bone to its normal position

• Normalization of the nasal roof height

• Complete relief of internal nasal valve stenosis

• Establishment of a stable internal nasal structure

• Improvement of the sunken nasal dorsum

Front view

• Restored symmetry of the left nasal bone

• Natural overall nasal contour

• Balanced facial proportions

Before surgery / Day 0 immediately after surgery Photos taken immediately after surgery show swelling and may differ from the final result.

Profile view

• Stable nasal framework

• Natural nasal line

• Harmonious facial profile

Before surgery / Day 0 immediately after surgery Photos taken immediately after surgery show swelling and may differ from the final result.

Functional improvement

• Complete resolution of left nasal obstruction

• Smooth breathing through improvement of internal nasal valve stenosis

• Significant reduction in pain at the osteotomy site

• Improvement in neuropathic pain patterns

• Improvement in columellar pain and laxity

Before surgery / Day 0 immediately after surgery Photos taken immediately after surgery show swelling and may differ from the final result.

Specialized care

• Recovery protocol tailored to atopic dermatitis

• Safe healing in the setting of immunosuppressant use

• Minimizing taping to prevent exacerbation of atopic dermatitis

Before surgery / Day 0 immediately after surgery Photos taken immediately after surgery show swelling and may differ from the final result.

This was a restorative case for a patient who suffered severe structural damage and functional impairment due to excessive osteotomy in a previous surgery. In particular, it was a demanding case because the procedure had to be carried out while the patient was taking immunosuppressants and managing atopic dermatitis.

When the patient visited our clinic, the most serious issue was the structural collapse resulting from excessive osteotomy of the left nasal bone. Due to the over-osteotomy, the nasal bone collapsed, bringing down the entire nasal vault along with it. Consequently, the left internal nasal valve became severely narrowed, directly impairing breathing.

The patient's persistent pain originated from this structural instability; in particular, the discomfort arising from the left osteotomy site presented with neuropathic features. When the nasal bone is collapsed, surrounding nerves endure continuous compression and irritation, which caused severe pain whenever touching the nose or washing the face.

The foremost priority was restoring the collapsed nasal roof. It was necessary to return the collapsed nasal bone to its normal position and simultaneously elevate the nasal roof to an appropriate height to resolve the internal nasal valve stenosis. To achieve this, upper lateral cartilage reconstruction and internal nasal valve reconstruction were performed concurrently.

Septal reconstruction was also essential. Reconstructing the damaged septum with autologous rib cartilage allowed us to stabilize the central axis of the nose and balance bilateral respiratory function. In particular, carrying this out in conjunction with elevating the nasal roof allowed us to secure the overall airway passage.

In this scenario, careful consideration had to be given to the patient's immunosuppressant regimen and atopic dermatitis. Because immunosuppressants can affect wound healing, more prudent surgical planning and recovery management were required, alongside meticulous adjustments such as minimizing taping to avoid aggravating the atopic dermatitis.

As a result, the collapsed nasal roof was successfully restored, and the internal nasal valve stenosis was resolved, completely recovering respiratory function. The discomfort characterized by neuropathic pain that had troubled the patient most was also significantly improved through structural stabilization.

This case was meaningful because it demonstrated that even severe functional impairment caused by complications from previous surgery can be thoroughly resolved through accurate diagnosis and systematic reconstruction. In particular, a successful outcome was achieved through tailored treatment that accounted for the patient's unique medical conditions.

This was Dr. Peter C. Kang. Thank you.

Thank you.

#closedrhinoplasty #osteotomyrestoration #autologousribcartilage #internalnasalvalvereconstruction #nasalroofrestoration #revisionrhinoplasty #respiratoryfunctionrecovery