CASE REPORT   

Otorinolaringologia 2019 September;69(3):185-7

DOI: 10.23736/S0392-6621.19.02210-0

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Unusual complication following septorhinoplasty

Kyle C. KILINSKI ¹, Enrico CAMPORESI ² ✉, Hershel R. PATEL ³, Mark H. TABOR ⁴

¹ USF Health Morsani College of Medicine, Tampa, FL, USA; ² Department of Anesthesiology and Critical Care, University of South Florida Morsani College of Medicine, Tampa, FL, USA; ³ Department of Ophthalmology, University of South Florida Morsani College of Medicine, Tampa, FL, USA; ⁴ Department of Otolaryngology, Head and Neck Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA

Septorhinoplasty is a commonly performed operation for nasal obstruction. Dynamic obstruction of the internal nasal valve is most commonly attributed to loss of nasal sidewall support due to weakness of the upper lateral cartilage. Flaccidity of the nasal septum following submucosal resection of the cartilage has the potential to cause a similar effect. A 37-year-old man presented with the complaint of an inspiratory noise described as a “seal’s bark” following nasal septorhinoplasty. The noise persisted despite two revision procedures including placement of spreader grafts to treat postoperative nasal valve obstruction. A videostroboscopy system was used in conjunction with a nasal endoscope to evaluate the nasal cavity while the noise was present. Dynamic lateral movement of a flaccid nasal septum during inspiration was noted along with the production of the offending noise. His symptoms were improved following multiple therapy sessions with a speech and language pathologist. An unusual inspiratory nasal noise can result from dynamic lateral movement of a flaccid nasal septum following aggressive septal cartilage resection. Cartilage preservation techniques with the goal of preservation of the structural rigidity of the nasal septum can help reduce the risk of this rare outcome. Therapy with a speech pathologist was able to dramatically reduce symptoms in this case.

KEY WORDS: Rhinoplasty; Nasal obstruction; Stroboscopy