Repair of nasal vestibular stenosis (eg, spreader grafting, lateral nasal wall reconstruction)
CPT4 code
Name of the Procedure:
Repair of Nasal Vestibular Stenosis (e.g., Spreader Grafting, Lateral Nasal Wall Reconstruction)
Summary
Repair of nasal vestibular stenosis is a surgical procedure designed to correct narrowing or blockage in the nasal vestibule — the front area of the nasal cavity. This may involve spreader grafting, which uses cartilage grafts to widen the nasal airway, or lateral nasal wall reconstruction to restore proper function and breathing.
Purpose
The procedure aims to alleviate nasal obstruction caused by structural issues within the nasal vestibule. Successful surgery can restore proper airflow, improve breathing, and enhance the overall quality of life by addressing symptoms such as difficulty breathing through the nose, chronic nasal congestion, and sleep disturbances.
Indications
- Chronic nasal obstruction not relieved by medical therapy
- Difficulty in nasal breathing affecting daily activities or sleep
- Previous nasal surgery causing vestibular stenosis
- Congenital nasal deformities
- Nasal trauma leading to structural abnormalities
Preparation
- Avoid eating or drinking for at least 8 hours before the procedure.
- Adjust or temporarily discontinue certain medications, as advised by your doctor.
- Have preoperative assessments such as physical examination, nasal endoscopy, and imaging studies (e.g., CT scan) to evaluate the extent of the stenosis.
Procedure Description
- Anesthesia: Administered—usually general anesthesia or local anesthesia with sedation.
- Incision: Small incisions are made inside the nose to access the nasal vestibule.
- Grafting/Reconstruction: Cartilage grafts (typically harvested from the septum, ear, or rib) are placed along the nasal sidewall to widen the airway. Alternatively, lateral nasal wall reconstruction may involve repositioning or restructuring the nasal tissues.
- Closure: Incisions are closed with dissolvable stitches, and sometimes nasal splints are placed to support the new structure during healing.
Tools: Surgical scalpel, nasal speculum, cartilage grafts, sutures. Technology: Endoscopic guidance may be used for precision.
Duration
Approximately 1 to 2 hours, depending on the complexity of the case.
Setting
The procedure is typically performed in an outpatient surgical center or a hospital operating room.
Personnel
- ENT Surgeons or Plastic Surgeons specializing in nasal surgery
- Anesthesiologist or Nurse Anesthetist
- Surgical Nurses and Technicians
Risks and Complications
- Bleeding or infection
- Scarring or poor healing
- Asymmetry or cosmetic dissatisfaction
- Persisting nasal obstruction
- Pain and swelling
Benefits
- Improved nasal airway function and breathing
- Relief from chronic nasal congestion
- Enhanced quality of life and sleep
- Reduced dependency on nasal sprays or other medications
Recovery
- Initial swelling and discomfort for the first few days; pain management will be provided.
- Avoid strenuous activities for at least 2 weeks.
- Nasal dressings and splints, if used, are typically removed after 1 week.
- Follow-up appointments to monitor healing and remove any sutures if necessary.
Alternatives
- Conservative treatments like nasal dilator strips, decongestants, or saline sprays
- Septoplasty or turbinate reduction, if nasal septum or turbinates are also contributing to obstruction
- Continuous Positive Airway Pressure (CPAP) for sleep apnea
Pros and cons should be discussed with your healthcare provider to determine the most appropriate treatment plan.
Patient Experience
- Some discomfort and swelling immediately after the procedure, typically managed with prescribed medications.
- Nasal congestion and drainage may occur as part of the healing process.
- Full recovery usually takes several weeks, with noticeable improvements in breathing within a few days to weeks.
- Follow all post-operative care instructions, including keeping the head elevated and avoiding nose-blowing.