Application of a Modified Costal Cartilaginous Framework in Correction of Severe Saddle Nose Deformity

Abstract

Background Insufficient support of the nasal septum due to congenital or secondary deficiency leads to severe saddle nose deformity which presents an unpleasant appearance. Objectives The purpose of this study is to present our approach to constructing a costal cartilaginous framework to correct severe saddle nose deformities with autologous costal cartilage. Methods A retrospective analysis was conducted of patients underwent correction of severe saddle nose deformity (Type II to Type IV) by a senior surgeon from January 2018 to January 2022. Preoperative and postoperative measurements were conducted to evaluate the surgical outcomes. Results A total of 41 patients aged from 15 to 50 years completed the study. The average follow-up time was 20.6 months. No short-term complication was observed. Revision operations were performed on three patients. All cases were satisfied with the aesthetic results. Analysis of objective measurements showed nasofrontal angle, columellar-labial angle, and tip projection improved significantly in Type II cases, nasofrontal angle and tip projection improved significantly in Type III cases, and tip projection improved significantly in Type IV cases. Conclusions Application of this modified costal cartilaginous framework which consists of a fairly stable foundation layer and an aesthetic contour layer of block costal cartilage has achieved satisfactory results in the long-term, which focuses on the aesthetic outcome while correcting the saddle nose deformity.

Application of Modified V-Y Advancement Flap in Alar Base Reduction

“…Rohrich and colleagues discuss how tip deprojection may worsen preoperative alar flaring, whereas tip projection may reduce alar flaring to the point that it might not be necessary to address it. 16,17,[25][26][27] Hence, it is recommended that the reduction of the alar base be performed last during rhinoplasty.…”

“…The long-term effectiveness of Gruber’s technique, 24 which involves tension-free alar release and medialization by suture fixation, is uncertain due to its high recurrence rate. Rohrich and colleagues discuss how tip deprojection may worsen preoperative alar flaring, whereas tip projection may reduce alar flaring to the point that it might not be necessary to address it 16,17,25–27 . Hence, it is recommended that the reduction of the alar base be performed last during rhinoplasty.…”

“…Among all the patients, 7 underwent both augmentation rhinoplasty and alar base reduction. For patients who also underwent augmentation rhinoplasty, the procedure was performed in accordance with the previous description 17 . During preoperative evaluation, it is important to consider the size, shape, and symmetry of the nasal base, as well as its width, position, and relationship with the columellar length and lobule height 12 .…”

“…For patients who also underwent augmentation rhinoplasty, the procedure was performed in accordance with the previous description. 17 During preoperative evaluation, it is important to consider the size, shape, and symmetry of the nasal base, as well as its width, position, and relationship with the columellar length and lobule height. 12 Particularly for patients undergoing augmentation rhinoplasty, the tip position and flaring will be greatly altered.…”