Extensional midline framework built with porous polyethylene implant (Medpor) in rhinoplasty

Abstract

Background:In East Asians, the main steps of rhinoplasty include the regulation of the nasal tip projection along with dorsal augmentation. A complete septal extension graft and columella strut graft are effective tools for the correction of unprojected tips and short noses. However, autologous cartilages cannot provide enough cartilage for the graft. Moreover, use of rib cartilages will leave an additional scar on the patient's chest, and these are not considered a common source of cartilage. Therefore, the authors used porous high-density polyethylene (Medpor) sheets to rebuild extensional midline framework in rhinoplasty.Objective: To study the possibility and the method of porous high-density polyethylene (Medpor) sheets used as extensional midline framework in rhinoplasty.Methods: From May 2012 to May 2016, 78 patients underwent primary rhinoplasty with a midline framework built with Medpor. The patients' ages ranged from 22 to 48 years (mean±SD, 26±5.2 years). Seventy-five patients were women, and three were men. The patients selected Medpor because of a lack of adequate autogenous septal cartilage and refusal to use rib cartilage.Results: The patients were followed up for 6 months to 4 years, with a mean follow-up period of 18 months, in 3-month intervals, and examined for extrusion, infection, and aesthetic outcomes. In the 78 patients, 156 pieces of Medpor graft were used with 78 extensional septal grafts and 78 columella strut grafts. Nasal tip projection and columella-labial angle were changed significantly after the surgery in 67 of the 78 patients. Complications occurred in 11 patients, of whom one had two minor complications of deviated tip and columella. Conclusion:The porous high-density polyethylene sheets are easier to handle and effective as materials to build an extensional midline framework in rhinoplasty. However, the size of the porous high-density polyethylene sheets should be tailored carefully based on the preoperative assessment; otherwise, severe complications will occur.