Nasal Reconstruction After Major Accident

PATIENT STORY

Zahid’s Nasal Reconstruction After Major Facial Trauma

Zahid was 19 and had just finished his first year at university when a road traffic accident left him with a severely fractured nose, a destroyed septum, a lacerated upper lip, and the loss of five teeth. Mr Annakan Navaratnam performed major nasal reconstruction using cartilage from Zahid’s ribs and ears to rebuild his nose from the inside out – restoring both its structure and his breathing. Zahid’s mother, Rabeya, was with him throughout his recovery and joined him to share their story.

Zahid was 19, in his first year at university, and it was the last day of term. He had been at the gym with friends, gone out to get food, and was on his way home along a country lane just after midnight when the car was involved in a serious accident.

“I just woke up and felt my nose was broken completely,” Zahid recalls. “My lip was cut too, and I’d lost some teeth.”

For Rabeya, the first sign that something was badly wrong came when she and her husband tried to call Zahid back. “We got a call from his phone, but when his dad answered, it wasn’t him – it was a policeman. That was the first shock.”

The accident had happened close to home. The family rushed to the scene, where the road had already been closed off. “The policeman just said he might have cut his lip. That was all he told us. But when we got to the hospital, it was awful.”

Recovering from the accident

Zahid’s nose had sustained a deep laceration along its length, and his upper lip had been torn away from much of his face. Five of his lower teeth had been knocked out on impact.

“At one point he told me he could feel his breathing coming through the gash in his nose,” Rabeya says. “It was the most traumatic thing we’d been through as a family.”

The relief, when it came, arrived in stages. “The first thing is that he’s alive. Then, when they did the scans, there was no internal damage and no spinal damage. So that was the second relief. After that, we thought – everything else, we can work with.”

In the immediate aftermath, Zahid’s wounds were closed with two layers of stitches, but no structural reconstruction was carried out. “They didn’t rebuild anything, they just stitched it back up,” Rabeya explains. The damage beneath the surface was extensive: the septum, the central structural support of the nose, had been destroyed, leaving one nostril almost completely obstructed and the breathing badly compromised.

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On the waitlist for nasal reconstruction

The NHS confirmed it could offer the reconstructive surgery Zahid needed, but with a waiting list of around a year and a half. “For us, at our age, a year and a half doesn’t seem that long. For him, it was like a life sentence,” says Rabeya.

“I’d had the whole summer ahead of me and lots of plans,” Zahid explained, “but suddenly everything changed in an instant. Friends would visit me, but I didn’t want to go out. I couldn’t go to the gym any longer. My sleep was badly affected.”

The family began looking privately and saw three consultants before being referred to Mr Navaratnam. None of the earlier consultations gave them confidence.

“The first one said he doesn’t do this kind of work – that was £275 gone. The second said he could do it, but we just didn’t feel sure.

The first consultation

The introduction to Annakan came, in the end, by chance, through a family friend who had researched a similar operation. “Having worked in private healthcare myself, I know it’s a minefield,” Rabeya says. “You’re just presented with a list of names, and you don’t know who to trust. And there’s a lot of money involved, plus the emotional toll.

“Every time we came out of an appointment without good news, it was another week of him feeling low. He was quite depressed at the time. It was really difficult.”

That changed after the family’s first meeting with Mr Navaratnam. “The three of us walked out feeling: you know what you’re talking about, you’re the right person. He does craniofacial work, which means complex, challenging surgery. We felt completely assured he was going to do a good job. “As a mother, I felt like my child’s life was in his hands, and he knew exactly what he was doing.”

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Rebuilding a nose from rib and ear cartilage

Mr Navaratnam saw the family in June and was able to offer a cancellation slot in mid-July; a matter of weeks, rather than the year and a half the family had been bracing for.

“The impact on you emotionally and mentally was huge. We felt we could move forward,” Rabeya says.

The operation itself took almost five hours. Because the septum and the structural cartilage of the nose had been so extensively destroyed in the accident, Mr Navaratnam needed to source rebuilding material from elsewhere in Zahid’s own body: cartilage from his ribs, and a sheet of soft connective tissue from behind his ears, to reconstruct the septum and rebuild the nasal framework from the inside. “He said it was one of the more technical challenges he’s done,” says Rabeya.

The original scar running down the length of Zahid’s nose was also revised during surgery. “You can’t even see it now,” Rabeya says. The lip injury, which had been closed in A&E in the hours after the accident, had healed well and needed no further surgery – something Mr Navaratnam confirmed at the consultation, to the family’s relief.

Zahid wore internal and external splints for two weeks following the operation. “The splints were the worst part. I couldn’t breathe properly, and it hurt when they came out,” he says. “But straight after, I could breathe so much better. Instantly.”

Returning to normal life after post-trauma rhinoplasty

Swelling in the weeks after surgery was significant, as expected with reconstruction of this scale, and Mr Navaratnam was clear from the outset that full settling of the result would take twelve to eighteen months, with the nose designed not just for how Zahid looks now, but for how his face will mature as he gets older.

More than a year on, Zahid has regained his confidence and even returned to boxing. “He’s reassured me my nose is fine now – it’s stronger,” Zahid says of Mr Navaratnam. “I’m really happy with it.”

For Rabeya, the outcome goes beyond appearance. “It’s not just the physical side, fixing his nose. Functionally, he feels great: his breathing, his sleep, all of it.”

The importance of choosing the right surgeon

Looking back on the months between the accident and surgery, Rabeya is candid about how much the search for the right consultant matters – not just clinically, but in how a family is treated along the way.

“For me, it wasn’t just the physical side, him fixing the nose. It was the reassurance, the way he spoke with Zahid and with us. It was respectful, and personal. Our consultations would often run over because we were just chatting.

“It was the whole package. If you’d asked me to pay another £10,000, I probably would have, because you can’t put a price on the experience we had, and the outcome of the operation itself.”

Asked what she would say to another family facing a similar situation, Rabeya doesn’t hesitate: find a surgeon who treats the whole person, not just the injury – someone who gives both patient and parent the confidence that they are genuinely in safe hands.

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The surgeon’s perspective

It was a pleasure to look after Zahid, and I looked forward to seeing him and his remarkable parents for follow-up consultations. This lovely gentleman, unfortunately, sustained a significant facial injury after a road traffic accident, which destroyed much of the cartilage in his nose. He underwent major nasal reconstruction under my care involving the use of his own rib and ear cartilage to completely reconstruct his nose and significantly improve his breathing.

After such a devastating injury, the impact of the distortion of the facial features combined with the significant functional limitations on breathing can be very overwhelming. My approach is to explain to patients what a realistic outcome is following major reconstructive nasal surgery. I go through the steps of the operation with diagrams and map out the recovery timelines, so the patient understands what to expect.

Zahid is a very robust and tough young man and dealt with the surgery and recovery well. It is also very important to have support when going through this type of treatment, and Rabeya and her husband were fantastic in guiding him.

I wish Zahid and his lovely family all the best in the future, and I hope I will still be invited to his wedding!

He kindly allowed his images to be shared 10 months after surgery.

LEARN MORE ABOUT ANNAKAN

Zahid’s Nasal Reconstruction After Major Facial Trauma

Recovering from the accident

On the waitlist for nasal reconstruction

The first consultation

Rebuilding a nose from rib and ear cartilage

Returning to normal life after post-trauma rhinoplasty

The importance of choosing the right surgeon

The surgeon’s perspective

Kind words from our patients

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