The endonasal rhinoplasty was performed via a hemitransfixion incision, and all portions of the deviated quadrangular cartilage
were removed, leaving a 1.5-cm caudal and dorsal L-strut.
In his technique, he had suggested removal of the quadrangular cartilage
, flattening it using a septal morselizer and placing it between the mucoperichondrial flaps.
We consider the most expedient in all cases to do a cut on a left-hand side, even at displacement of the first line or a dislocation of a quadrangular cartilage
. The cut is usually made in front--on the edge of a cartilage of nasal septum.
After nasal suctioning of debris, examination of the septum revealed the presence of a 6-ram perforation along the anterior portion of the quadrangular cartilage
. The patient's mother was encouraged to continue applying the antimicrobial ointment and to follow up in a few weeks for monitoring of the perforation's progression.
To create this flap, the surgeon first makes a hemitransfixion incision and elevates the mucoperichondrium on both sides of the remaining caudal quadrangular cartilage
back to the anterior margin of the perforation.
Maintaining an intact septal L strut and keystone area (i.e., the junction of the dorsal quadrangular cartilage
and the perpendicular plate) is imperative in order to prevent nasal-tip collapse.
Analysis of biopsy specimens revealed some exposed bone and an absence of quadrangular cartilage
. Extensive destruction of his maxillary walls was also noted.