Nasal Dorsal Augmentation Research Articles

Ultrasound visualization of augmentation rhinoplasty using diced cartilage framework: A pictorial study

Diced cartilage (DC) plays an integral role in rhinoplasty, and its application is well established in nasal dorsal augmentation rhinoplasty as a diced cartilage framework (DCF). Fifteen patients requiring nasal dorsal augmentation were included. Two different types of DCF were applied: DC wrapped in fascia lata or Lyomesh® and DC embedded in platelet-rich fibrin (PRF). Postoperative ultrasound follow-ups were performed at intervals of one month, three months, and one year after surgery using a high-frequency linear ultrasound transducer. The aim was to depict the viability of the DCF in vivo. DCF was successfully depicted using ultrasound imaging in all 15 patients. Ultrasound rendered DC as hypoechoic and inhomogeneous areas. Perifocal hypoechoic edema was detected, which significantly decreased by the one-year follow-up. During the one-year postoperative period, very little DC had decreased in diameter and the framework was fully intact, with no signs of migration. On high-frequency ultrasound, DC wrapped in fascia lata or Lyomesh® appeared as a hypoechoic and inhomogeneous area clearly limited by a thin hyperechoic envelope material, whereas DC embedded in PRF presented as a hypoechogenic area that spread laterally along the bone and nasal cartilage on both sides. Using color Doppler imaging, neovascularization of the DCF was identified in 7 of 15 patients at the postoperative examination. High-resolution ultrasound is an accurate, non-invasive imaging method appropriate for visualizing DCF in augmentation rhinoplasty. Additionally, it is possible to detect nascent neovascularization within grafts by using color Doppler imaging.

Customizable, biocompatible implants for dorsal nasal augmentation: An in vivo pilot study of eight polylactic acid scaffold designs.

Augmentation of the nasal dorsum often requires implantation of structural material. Existing methods include autologous, cadaveric or alloplastic materials and injectable hydrogels. Each of these options is associated with considerable limitations. There is an ongoing need for precise and versatile implants that produce long-lasting craniofacial augmentation. Four separate polylactic acid (PLA) dorsal nasal implant designs were 3D-printed. Two implants had internal PLA rebar of differing porosities and two were designed as "shells" of differing porosities. Shell designs were implanted without infill or with either minced or zested processed decellularized ovine cartilage infill to serve as a "biologic rebar", yielding eight total treatment groups. Scaffolds were implanted heterotopically on rat dorsa (N = 4 implants per rat) for explant after 3, 6, and 12 months followed by volumetric, histopathologic, and biomechanical analysis. Low porosity implants with either minced cartilage or PLA rebar infill had superior volume retention across all timepoints. Overall, histopathologic and immunohistochemical analysis showed a resolving inflammatory response with an M1/M2 ratio consistently favoring tissue regeneration over the study course. However, xenograft cartilage showed areas of degradation and pro-inflammatory infiltrate contributing to volume and contour loss over time. Biomechanical analysis revealed all constructs had equilibrium and instantaneous moduli higher than human septal cartilage controls. Biocompatible, degradable polymer implants can induce healthy neotissue ingrowth resulting in guided soft tissue augmentation and offer a simple, customizable and clinically-translatable alternative to existing craniofacial soft tissue augmentation materials. PLA-only implants may be superior to combination PLA and xenograft implants due to contour irregularities associated with cartilage degradation.

Outcomes of dorsal nasal augmentation using costochondral graft.

To assess functional and aesthetic outcomes in patients having undergone dorsal nasal augmentation with costochondral graft in a tertiary care setting. The single-centre, retrospective, observational study was conducted at Shifa International Hospital, Islamabad, Pakistan, and comprised data of patients who underwent dorsal nasal augmentation using costochondral graft between January 1, 2018, and December 31, 2022. Aesthetic outcomes in terms of patient satisfaction were assessed using Facial Appearance, Health-related Quality of Life and Adverse Effects scores. Data was analysed using SPSS 26. Of the 46 patients, 28(61%) were males and 18(39%) were females. The overall mean age was 28.39±9.13 years. Dorsal nasal deficiency occurred secondary to congenital causes in 12(26.1%) patients, trauma 19(41.3%) and prior surgery 15(32.6%). Postoperative complication rate was 7(15%); 3(6.5%) had recipient site infection and 2(4.3%) had rib graft resorption. Besides, 1(2.2%) patient reported pain 2 months postoperatively and 1(2.2%) had hypertrophic scarring. Patient satisfaction with the outcome was noted in all the 10 parameters analysed. Most commonly reported problem was that the nose was 'looking thick/swollen' by 12(26.1%) patients, but the issue resolved during 1-year follow-up. Costochondral graft was found to be an ideal material for dorsal nasal augmentation, with high patient satisfaction rate.

Outcomes of dorsal nasal augmentation using costochondral graft

Objective: To assess functional and aesthetic outcomes in patients having undergone dorsal nasal augmentation with costochondral graft in a tertiary care setting. Method: The single-centre, retrospective, observational study was conducted at Shifa International Hospital, Islamabad, Pakistan, and comprised data of patients who underwent dorsal nasal augmentation using costochondral graft between January 1, 2018, and December 31, 2022. Aesthetic outcomes in terms of patient satisfaction were assessed using Facial Appearance, Health-related Quality of Life and Adverse Effects scores. Data was analysed using SPSS 26. Results: Of the 46 patients, 28(61%) were males and 18(39%) were females. The overall mean age was 28.39+9.13 years. Dorsal nasal deficiency occurred secondary to congenital causes in 12(26.1%) patients, trauma 19(41.3%) and prior surgery 15(32.6%). Postoperative complication rate was 7(15%); 3(6.5%) had recipient site infection and 2(4.3%) had rib graft resorption. Besides, 1(2.2%) patient reported pain 2 months postoperatively and 1(2.2%) had hypertrophic scarring. Patient satisfaction with the outcome was noted in all the 10 parameters analysed. Most commonly reported problem was that the nose was ‘looking thick/swollen’ by 12(26.1%) patients, but the issue resolved during 1-year follow-up. Conclusion: Costochondral graft was found to be an ideal material for dorsal nasal augmentation, with high patient satisfaction rate. Key Words: Costal cartilage, Patient satisfaction, Rhinoplasty.

A modified technique for autologous dorsal nasal augmentation rhinoplasty.

Autologous dorsal cartilage grafts are usually the first choice for nasal augmentation. We aimed to describe a modified technique for autologous dorsal nasal augmentation rhinoplasty. The study group consisted of a retrospective review of patients who underwent augmentation rhinoplasty surgery and were treated with diced cartilage in platelet-rich plasma (PRP) in the last five years at King Abdulaziz University Hospital. Gender, age, smoking history, saddle nose etiology, complications, mean duration of surgery, mean duration of hospital stay, morbidity, mortality, and surgical technique used were assessed and analyzed. The outcome of this technique was compared with other techniques used for augmentation rhinoplasty published in the current literature. A selective, retrospective analysis was conducted on patients undergoing rhinoplasty between 2017 and 2022. A total number of 30 patients' files were reviewed; of those, eight patients were males, and 22 were females. The average age of the participants was 33, with a minimum of 19 years and a maximum of 55. The indications for surgery are listed in Table II. Cartilage graft was harvested from the concha in 14 patients, from the septum in eight patients, and from both sites in eight. Male and female samples are shown in Figures 1 and 2. We have only observed graft resorption in two female cases, and none of the patients had any complications. We have assessed the patients who underwent rhinoplasty with the modified technique for autologous dorsal augmentation. The combination of diced cartilage and PRP yielded good results with a low resorption incidence; when done correctly, no complications were observed. Platelet-rich plasma (PRP) contains a greater volume of platelets and Platelet-Derived Growth Factors, which exert multiple actions on different aspects of reparative and regenerative tissue phenomena. Augmentation rhinoplasty using PRP offers stabilization and enclosure of diced cartilage without the risks of hypersensitivity or disease transmission.

Success and Complication Rates of Different Techniques and Materials Used for Nasal Dorsal Augmentation in Rhinoplasty

Abstract Background Autologous materials, homograft and alloplastic implants are commonly used in nasal dorsal augmentation. So far, there is no satisfactory evidence to ascertain the safest, efficient, and superior in aesthetic outcomes among different materials. Thus, we aimed to conduct a systematic review and metaanalysis (SR, MA) of published literature to review rates of outcomes and complications of different materials used for nasal dorsal augmentation, in trial for better future surgical results. Methods Thirteen electronic databases were searched from inception through December 2018 and a manual search in October 2019. Results A total of 280 eligible studies were included, of which 165 articles were included in the meta-analysis. Compared to others, alloplastic expanded polytetrafluoroethylene (alloplastic e-PTFE) was considered first place, for having the highest graft scores in most of its outcomes; secondary deformity, resorption, patients’ satisfaction, displacement, extrusion, seroma, graft deviation, swelling, and hematoma outcomes with rates of (2%, 0.6%, 96.5%, 1.3%, 1.2%, 1%, 1%, 0.8%, 0.8%)respectively. Alloplastic silicone came after e-PTFE, for its superior results in revision rhinoplasty, success rate, aesthetic function, and scarring outcomes (4.1%, 99.9%, 98.8%, 2.7%) respectively. Autologous bone graft came at the last place as it had the least graft scores in patients’ satisfaction, displacement, perforation, and hematoma outcomes (50.7%, 9.3%, 8.3%, 5.4%)respectively. Autologous diced cartilage was superior in those outcomes; edema, bruising, and donor site complications (7.1%, 7.4%, 4.4%) respectively. Autologous costal cartilage had the highest graft scores in necrosis and graft exposure outcomes (4.3% and 1.9%), while it had the lowest graft scores in warping and success rate (7.1% and 87.3%). Autologous auricular cartilage had the highest graft scores in warping and foreign body reaction outcomes (1.4% and 6.3%), while it had the lowest graft scores in nasal obstruction and donor site complications rate (72.7% and 33.3%). Infection was the most common reported complication in MA, where autologous alar cartilage had the lowest infection rate of 0.2%, unlike alloplastic Medpor recorded the highest risk of 6.6%. Conclusions Regarding our results, we concluded that alloplastic e-PTFE yielded superior position in comparison to other materials, that would succeed as an alternative to convential autologous grafts, as had superior results in most of nasal dorsal augmentation outcomes. On the other hand, autologous bone graft was in the last place in all its outcomes. Future studies are needed to improve reporting of races variety, follow-up times, and diverse participants, as to resolve uncertainty regarding the ideal material for dorsal augmentation in rhinoplasty, with concentrating on proper assessment of races variety, which will improve selecting the proper graft implant.

Injectable Cartilage Microtissue Regenerated by Autologous Chondrocytes for Nasal Augmentation: A 5-Year Follow-Up Study.

A lack of ideal filling materials is a critical limitation in current rhinoplasty. Cartilage sheet regeneration by autologous chondrocytes is expected to provide an ideal source of material. However, the inability to perform minimally invasive transplantation of cartilage sheets has greatly limited the clinical application of this material. In this article, the authors propose the concept of injectable cartilage microtissue (ICM) based on cartilage sheet technology, with the aim of achieving minimally invasive augmentation rhinoplasty in clinical practice. Approximately 1.0 cm2 of posterior auricular cartilage was collected from 28 patients. Isolated chondrocytes were expanded, then used to construct autologous cartilage sheets by high-density seeding and in vitro culture in chondrogenic medium with cytokines (eg, transforming growth factor beta-1 and insulin-like growth factor-1) for 3 weeks. Next, ICM was prepared by granulation of the cartilage sheets; it was then injected into a subcutaneous pocket for rhinoplasty. ICM was successfully prepared in all patients, and its implantation efficiently raised the nasal dorsum. Magnetic resonance imaging confirmed that regenerative tissue was present at the injection site; histologic examinations demonstrated mature cartilage formation with typical cartilage lacunae and abundant cartilage-specific deposition of extracellular matrix. Excellent or good postoperative patient satisfaction results were achieved in 83.3% of patients over 5 years of follow-up. Obvious absorption of grafts occurred in only two patients (8.3%). These results demonstrated that ICM could facilitate stable cartilage regeneration and long-term maintenance in the human body; the implantation of ICM enabled natural augmentation of the depressed nasal dorsum. Therapeutic, IV.

Asian rhinoplasty using a thin rib cartilage graft and ultrafine diced cartilage wrapped in fascia: A comparative study between septal cartilage graft and rib cartilage graft

A 1-2-mm thin rib cartilage graft was used as a septal extension graft to overcome the drawbacks of traditional rib cartilage rhinoplasty, which often results in a stiff nasal tip. The remaining rib cartilage was placed on the nasal dorsum as an ultrafine diced cartilage wrapped in fascia (UDCWF) graft. This study aimed to assess the stability of thin rib cartilage grafts and measure the resorption rate of the UDCWF graft. This retrospective study included 53 patients who underwent rhinoplasty with septal extension grafting and nasal dorsum augmentation using a septal cartilage (SC group) or rib cartilage (RC group) graft between June 2017 and June 2020. The nasal length, tip height, sellion height, and nasolabial angle in the preoperative, immediate postoperative, and long-term postoperative periods were analyzed using three-dimensional photogrammetry. A total of 26 patients received rib cartilage grafts and 27 patients received septal cartilage grafts. The RC group showed greater maintenance of tip height, nasal length, and tip derotation over time. The relapse ratio in tip height was -3.3±1.6% and -8.4±4.3% in the RC and SC groups, respectively (p=0.001). The resorption rate of the UDCWF graft was -7.5±3.6% and -7.8±2.3% at the sellion and rhinion, respectively. The thin rib cartilage provided sufficient intrinsic strength to maintain tip height and tip rotation. It can be an effective alternative to rhinoplasty in Asians with features such as thick skin and a short nose. Moreover, the UDCWF graft exhibited an approximately 7.5% resorption rate, leading to lower probabilities of dorsal irregularity and stepping deformity.

A Combination Method of Costal Cartilage Injection Techniques for Augmentation Rhinoplasty.

The multiple toothpick-shaped costal cartilage (MTCC) injection technique was introduced as an improvement based on the free diced costal cartilage (FDCC) injection technique for augmentation rhinoplasty. However, radix irregularities may occur when using the MTCC technique. Considering that the FDCC grafts are easier to shape at the nasal radix, we adopted a combination method of the 2 techniques to achieve natural and smooth contour. Four patients accepted this method for augmentation rhinoplasty. Through a unilateral marginal incision, the costal cartilage grafts were injected for nasal augmentation at the subperiosteal plane. The FDCC grafts and the MTCC grafts were used for nasal radix and dorsum augmentation, respectively. Nasal contour was adjusted by external shaping. The follow-up ranged from 24 to 43 months. All patients were satisfied with the surgical outcome. There were no major complications occurred during the follow-up. One patient underwent rasping revision due to her own beauty-appreciation changes. The combination method can take advantages of the FDCC and MTCC injection techniques. It can effectively lower the incidence of contour irregularities and graft displacement. Meanwhile, it is easy to perform without special procedure, and is time-saving and cartilage-saving.

P12. MODERNIZING GEPPETTO’S WORKSHOP: PREDICTING AESTHETIC OUTCOMES OF 3D-PRINTED, PATIENT-SPECIFIC DORSAL NASAL IMPLANTS UTILIZING A NOVEL IMAGING PROTOCOL

PURPOSE: To develop a low-cost, rapid protocol for the design and production of custom-fabricated dorsal nasal implants. METHODS: For protocol validation, we utilized facial CT data to provide “ground truth” patient anatomy. Using these data, 3D models of the subject’s skull and soft tissue were 3D-printed with polylactic acid (PLA) and cast in silicone, respectively. This “face phantom” was imaged to generate a 3D photograph utilizing commercially available photogrammetry software. Desired augmentation was determined via virtual deformation of this model. A corresponding, custom-designed dorsal nasal implant was 3D-printed in PLA, implanted on the phantom, and reimaged as above. To demonstrate fidelity, the photogrammetrically-derived model with and without augmentation was co-registered and compared to CT-derived “ground truth”. RESULTS: Photogrammetric comparison between the 3D photograph and CT-derived “ground truth” revealed an average Hausdorff distance of 0.198 mm (95% 0.640 mm; Dice coefficient=0.989). Dorsal nasal augmentation revealed an average Hausdorff distance of 0.381 mm (95% 1.56 mm; Dice coefficient=0.978) compared to “ground truth.” Comparison between expected and actual augmentation revealed an average Hausdorff distance of 0.276 mm (95% 1.24 mm; Dice coefficient=0.985). Heatmap analysis demonstrated high congruence in all relevant anatomical areas, with variation exclusively noted along the nasal dorsum as expected. CONCLUSION: Our imaging protocol produces a highly accurate means of capturing critical facial anatomy necessary for design of custom-fabricated dorsal nasal implants.

Composite Dorsal Augmentation.

Dorsal augmentation is one of the most challenging procedures in rhinoplasty. Solid grafts and diced fascia graft (DC-F) have been employed for this purpose with varying success. Warping, irregularities, and variability of final height are some of the potential pitfalls. The aim of this study was to assess the efficiency of the authors' approach combining multiple grafts for nasal dorsal augmentation. They described a technique employing composite dorsal augmentation that is a combination of a foundation layer utilizing high spreader grafts plus a dorsal gap graft combined with a contour layer of 3 possible types of fascia or DC-F grafts. The combination of the 2 layers for the nasal dorsum can be varied to achieve the required height to correct the patient's deformity and achieve the desired aesthetic goals. Fifty-one patients who underwent dorsal augmentation with composite technique between 2017 and 2020 were retrospectively reviewed. A step-by-step algorithm was applied to achieve the required dorsal height. The patients were divided into 3 groups according to the type of contour graft: double-layer fascia graft, segmental DC-F, or narrow thin full-length DC-F. Smooth continuity and increased projection of the nasal dorsum were achieved in all patients. Composite dorsal augmentation is an effective technique for dorsal augmentations requiring 4 mm or more of height increase. This technique allows to achieve dorsal augmentation employing a combination of grafts from a single donor site together with camouflaging dorsal irregularities and highlighting dorsal aesthetic lines. This algorithm allows optimization of patients' aesthetic profile.

Midface advancement in an adult patient with Crouzon syndrome: Modified LeFort III + LeFort I osteotomy accompanied by genioplasty and nasal dorsum augmentation

Crouzon syndrome is an autosomal dominant trait, leading to midface deficiency, undeveloped orbits, short nasal dorsum, and exophthalmos as the typical clinical features. Early correction of craniofacial problems can improve patients' quality of life, but many of these patients with Crouzon syndrome are seeking treatment in older ages when they are missed for multidisciplinary management and distraction technique in proper timing. Modified LeFort III osteotomy is one of the treatment options that can be used for proper resolution in adult patients. The present case report study aims to describe a patient with midface deficiency due to the Crouzon syndrome who has undergone a combination of modified LeFort III osteotomy with the periocular approach and LeFort I osteotomy, nasal dorsum augmentation accompanied by genioplasty, wholly as a single surgical procedure which has been shown that can result in highly satisfactory outcomes for both patient and surgeon.

Anatomical Study of the Dorsal Nasal Artery to Prevent Visual Complications during Dorsal Nasal Augmentation.

Summary:Dorsal nasal augmentation is a common injection associated with ocular complications. Digital compressions on both sides of the nose are recommended during injection. Considering the reported incidences of visual complications, this preventive technique may need an adjustment for more effectiveness to prevent blindness. Therefore, the dorsal nasal arteries (DNAs) were studied by conventional dissections in the subcutaneous and fibromuscular tissues of the nasal dorsum in 60 embalmed cadavers. The results showed that among the 60 faces, 32 faces had bilateral DNAs (53.3%), 23 had dorsal nasal plexus with minute arteries (38.3%), and five had a single dominant DNA (8.3%). The DNA originated from one of the four arterial sources, which influenced the location and course of the artery. These sources included the ophthalmic angular arteries in 21 faces (56.8%), terminal ophthalmic arteries in two faces (5.4%), lateral nasal arteries in 11 faces (29.7%) and facial angular arteries in three faces (8.1%). Consequently, the dominant dorsal nasal artery running close to the midline found in 8% of the cases could make side compressions during nasal dorsum augmentation less effective from preventing ocular complications. However, an adjustment of digital compressions which combines pinching and side compressions is suggested to improve the safety.

Perichondrial Attached Diced Cartilage (PADC), a Novel Graft Material for Nasal Augmentation: 10 Years of Experience.

Achieving dorsal augmentation with onlay grafts presents several challenges. Visibility and warping of grafted cartilages can ruin an otherwise successful operation. A shortage of septal cartilage and rib donor site morbidity compound the problems associated with this procedure. The aim of this study was to find an autologous material for dorsal nasal augmentation that does not disperse upon implementation. This material also should have minimal resorption, resist warping, and not require a wrapping membrane. In 30 patients, concha cartilage of the ear with attached perichondrium and fascia were removed. The concha cartilage was diced while it was attached to the posterior soft tissue. The purpose was to develop graft material for dorsal augmentation. In an average of 19.56 months follow-up, no sign of resorption, infection, inflammation, volume loss, or displacement of the grafted material was observed. Aesthetically the results were acceptable and most of the patients were satisfied with the outcome. Perichondrial attached diced cartilage is a new material for the rhinoplasty surgeon to apply in different onlay nasal augmentation procedures in the unduly reduced nasal dorsum. This technique transforms uneven, peculiarly shaped concha cartilage into a flexible, versatile, and durable material. The donor site is in the surgical field and easy to access.

A Systematic Review and Meta-Analysis of Complications Associated With Autogenous Diced Cartilage Wrapped in Fascia Used in Nasal Dorsum Augmentation.

Nasal dorsum augmentation is a highly challenging rhinoplastic procedure. Problems encountered in this surgery, such as residual humps, irregularities, and asymmetry, account for a significant number of revision rhinoplasties. The aim of this meta-analysis was to assess complication rates and graft harvesting site morbidity and revision rates. We carried out a systematic review of the literature for pertinent materials in PubMed/Medline and Google Scholar up to and including August 2020. In addition, the reference list of included studies was searched manually. The criteria used were those described in the PRISMA Declaration for performing systematic reviews. The initial search yielded 236 results. After 3 stages of screening, 16 papers (18 groups) were included in the systematic review and meta-analysis. Our results indicated that the total rates for the complications studied were as follows: graft resorption, 2.52%; insufficient augmentation, 3.93%; deviation (graft displacement), 1.77%; infection, 2.30%; irregularity, 1.36%; supra-tip depression, 1.13%; overcorrection, 3.06%; hematoma at recipient site, 1.36%; and visible bulging of the graft, 2.64%. The total rates for donor site hypertrophic scar and donor site hematoma were 2.64% and 3.58%, respectively. The rate of the revision surgery was 3.03%. Current findings suggest the overall complications and revision rates with the use of diced cartilage wrapped in fascia for dorsum augmentation were relatively low and this technique is a reliable treatment choice for patients with primary/secondary dorsum deficiencies. Further studies with larger sample sizes and long-term follow-ups, clearer definitions of complications, and objective measurements are warranted to draw reliable practical conclusions.

Our Strategy in Management of Maxillonasal Dysplasia in Pediatric Patients.

Maxillonasal dysplasia or Binder syndrome is an uncommon condition. It is a congenital disease characterized by undergrowth of the central face and may include elements of the nose and upper jaw. The hallmark of the deformity is a retruded mid-face and an extremely flat nose. The timing and the surgical approaches for management of such deformity are still controversial. In this paper, we are going to present our experience in management of Binder syndrome in children. Seven children ranging in age from 6 to 13 years with classic features of Binder syndrome were operated upon in this study. The surgical approach was done at an early age and included 3 main components; nasal dorsum augmentation by costal cartilage graft, maxillary augmentation by rib grafts and columellar reconstruction by VY-plasty and strut grafts. Patients were followed for up to 6 years. Excellent results were obtained in all patients with this surgical procedure. Half of our patients required more than 1 surgery but none of them required any secondary orthognathic surgery. Therefore, we recommend that children with Binder syndrome should be managed at an early age at least for correction of their nasal deformities. Maxillary augmentation can also be done simultaneously or delayed for a second stage. During the second stage, further nasal augmentation can be accomplished. Definitive orthognathic surgeries have to be postponed to adolescence. This strategy can dramatically improve the patient aesthetic and alleviate the psychological upset without much disturbance of the facial growth.

Inferior Turbinate Bone Graft for Dorsal Augmentation in Rhinoplasty.

The most serious form of nasal dorsum pathologies is saddle nose deformity. Vary of nasal dorsal augmentation grafts were reported in the literature but inferior bone graft (ITBG) alone has not attracted attention. The ITBG has advantages such as easy and fast harvesting, easy to shape due to cancellous bone tissue. The graft technique is similar to the inferior turbinoplasty with the medial mucosal flap technique and can be performed without bioabsorbable hemostatic material (e.g. Turkish Delight), suture fixation, or without tissue adhesives. Major complications of the ITBG technique are injury of the posterior lateral nasal branch of the sphenopalatine artery and subdermal mucous cyst that developing on nasal dorsum. Since easy application, fast harvesting, and similar permanence to cartilage grafts as augmentation material, ITBG can also been used successfully in minor dorsal deficits in addition to saddle nose deformities.

Augmentation rhinoplasty using olecranon bone graft.

Background:Correction of saddle nose deformity is one of the most frequently sought surgeries by patients seeking rhinoplasty in Asian countries. Nasal dorsal augmentation always requires graft material to achieve the desired result. Various autologous grafts and alloplastic materials have been described in the literature with their advantages and disadvantages. We report our study on the use of olecranon bone graft for augmentation rhinoplasty in severe saddle nose deformity and discuss our experience with it.Materials and Methods:In this observational study, 12 patients who underwent dorsal nasal augmentation using olecranon bone graft from August 2011 to December 2020 were studied. All ten patients with congenital deformity underwent graft insertion through a closed rhinoplasty approach, whereas two patients with posttraumatic deformity were operated through old scars over the nasal dorsum. The graft was fixed with screws at nasion in both posttraumatic cases. All the patients were evaluated postoperatively at regular intervals for graft resorption by clinical photographs and X-ray nasal bone.Results:The age ranged from 20 years to 48 years. No immediate complications related to graft placement were noted. One patient had a hairline fracture of the ulna at the donor site on the 3rd postoperative day which was managed conservatively with a cast. The mean follow-up period was 2 years. No nasal dorsum projection loss or signs of bone resorption were observed for up to 5 years after surgery. One patient with posttraumatic deformity required removal of fixation screw which got exposed after 2 years of surgery.Conclusion:Olecranon bone graft is a suitable material for nasal dorsal augmentation in severe saddle nose deformity because of ease of harvest and minimal donor area morbidity. The appropriate thickness of the cortex of the olecranon process allows custom molding and provides resistance to resorption in long term, thereby giving a desirable outcome.

Evaluation of the effectiveness of the use of free diced cartilage in dorsal and tip nasal rhinoplasty

BackgroundRhinoplasty is considered one of the most challenging operations in the plastic surgery. Esthetic or functional reshaping purposes of the nose can be stressing for both surgeon and patient. Different types of graft materials have been used to perform augmentation rhinoplasty. Free diced cartilage (FDC) was recently established in dorsal nasal rhinoplasty for better handling of irregularities as well as contour deficits of dorsal nasal outcomes. The main purpose of the present study is to assess the effectiveness of the use of FDC in dorsal nasal and nasal tip rhinoplasty and evaluation of its advantages and disadvantages using the validated Nasal Obstruction Symptom Evaluation (NOSE) scale and the Rhinoplasty Outcome Evaluation (ROE) questionnaire to assess nasal obstruction and patient satisfaction.ResultsThis prospective study was conducted between March 2018 and December 2019, 20 patients were included and planned for rhinoplasty using FDC to camouflage dorsal and nasal tip deformities. All patients (11males and 9 females) underwent open rhinoplasty through inverted v columellar incision, taken FDC from nasal septum. A statistical significant difference between pre- and post-operative NOSE scores was found (P < 0.001). Post-operative rhinoplasty outcome evaluation scores ranged from 45 to 100 with mean ± SD (83.15 ± 13.22). Excellent satisfaction was the most noted in 17 patients (85%), while 2 patients (10%) reported good satisfaction and 1 patient (5%) with acceptable satisfaction.ConclusionIt was found that the FDC technique is an effective method for camouflage and augmentation of nasal dorsum as well as nasal tip in reconstructive and esthetic rhinosurgery for either primary or secondary rhinoplasty.

New Concepts in Dorsal Nasal Augmentation.

Dorsal augmentation is commonly indicated in many primary and secondary aesthetic nose surgeries. Throughout the history, various synthetic and autogenous materials have been used for dorsal augmentation. In this article, we give an overview of basic concepts of cartilage grafting, review new concepts of dorsal augmentation, and discuss some emerging engineering modalities.