Reconstruction of significant saddle nose deformity using autogenous costal cartilage graft with incorporated mirror image spreader grafts

Ahmed, Abu Saleh; Imani, Pedram; Vuyk, H. D.

doi:10.1002/lary.20736

Cited by 15 publications

(9 citation statements)

References 20 publications

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“…The spreader grafts are typically oriented with opposing convexities. 11 Multiple or asymmetric grafts may be placed to account for middle vault width or collapse. To assess, digital This document was downloaded for personal use only.…”

Section: Management Of the Middle Thirdmentioning

confidence: 99%

3 The Use of Costal Cartilage for Dorsal Augmentation and Tip Grafting

Jin¹

2016

Aesthetic Plastic Surgery of the East Asian Face

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Section: Management Of the Middle Thirdmentioning

confidence: 99%

3 The Use of Costal Cartilage for Dorsal Augmentation and Tip Grafting

Jin¹

2016

Aesthetic Plastic Surgery of the East Asian Face

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“…Although 90% of warping occurs within 1 h, warping may continue until a month after initial harvesting [10]. Besides, as has been suggested in some studies, a pair of spreader grafts customized from costal cartilage can cause widening of the nasal dorsum [3]. To prevent warping and preventing nasal dorsum widening with a pair of spreader grafts, a novel technique using costal cartilage as spreader grafts in a specially designed way is described.…”

Section: Introductionmentioning

confidence: 99%

“…Nasal septum deviation is the most common cause of nasal obstruction [1], and submucosal septal resection is routinely performed as treatment [2]. Although removal of the deviated septum improves nasal airways in most patients postoperatively, over-resection without supportive reconstruction may cause further problems, including nasal tip deprojection and over-rotation, deprojection of the dorsum and pseudo-hump formation, columellar retraction or broad nasal tip [3,4]. To prevent these deformities, preservation of the L-strut is crucial.…”

Section: Introductionmentioning

confidence: 99%

“…Since conchal cartilage is usually inadequate, lacks strength, and can easily be twisted, costal cartilage grafts are often preferred as spreader grafts for reconstruction. The main disadvantage of using costal cartilage grafts is its potential to warp [3]. Although 90% of warping occurs within 1 h, warping may continue until a month after initial harvesting [10].…”

Section: Introductionmentioning

confidence: 99%

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Dorsocaudal reconstruction of previous caudal septal resections with partial split spreader graft

Ekinci

Can

Koçman³

2022

J Surg Med

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Background/Aim: Nasal obstruction is caused mainly by nasal septal deviation, and submucosal resection is usually performed to treat this problem. However, if over-resected, nasal tip deprojection, deprojection of the dorsum, or pseudo-hump formation may be seen. Spreader grafts are used to restore the nasal septum in these cases, and different techniques have been described for this restoration; however, these techniques may not be the best fit for such restoration. This study presents a novel and effective method for septal reconstruction in patients with previous septal resections. Methods: Between March 2012 and October 2014, a case series of 14 male patients with tip deprojection and pseudo-hump formation who had undergone corrective surgery in our clinic was retrospectively examined. Partial-split, caudal extension costal spreader grafts were used and were fixed to the dorsum of the remnant septum cranially to prevent warping while avoiding nasal dorsum widening. Pre- and post-operative comparisons were performed, and the Nasal Obstructive Symptoms Evaluation questionnaire for the functional results and subjective Esthetic Appearance test for the esthetic outcomes were administered. Results: The mean age was 36.8 years (19–56 years), and the mean follow-up time was 14.6 months. Functional outcomes and esthetic appearance led to significantly improvements in all post-operative categories (P < 0.05) without any major complications. Common complaints were usually the same as seen in conventional rhinoplasty procedures, such as facial swelling, nasal stuffiness, pain, and/or epistaxis. None of the patients requested revision surgery. Conclusion: Using partial-split, caudal extension costal spreader grafts in the reconstruction of dorsocaudal septum in patients with previous septal resections appears to provide favorable functional and esthetic results.

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“…Recent studies have revolved around the role the septum plays in the formation of this complex abnormality. [7][8][9][10][11][12] We believe that the goal of saddle nose reconstruction should be not only to restore an aesthetic dorsum but also to restore the supportive nasal framework to improve breathing and achieve a stable long-term result. An algorithm, the Cakmak algorithm, developed by the senior author (O.C.)…”

mentioning

confidence: 99%

Identifying Septal Support Reconstructions for Saddle Nose Deformity

Cakmak¹,

Emre

Özkurt

2015

JAMA Facial Plast Surg

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The saddle nose deformity is one of the most challenging problems in nasal surgery with a less predictable and reproducible result than other nasal procedures. The main feature of this deformity is loss of septal support with both functional and aesthetic implications. Most reports on saddle nose have focused on aesthetic improvement and neglected the reestablishment of septal support to improve airway. OBJECTIVES To explain how the Cakmak algorithm, an algorithm that describes various fixation techniques and grafts in different types of saddle nose deformities, aids in identifying saddle nose reconstructions that restore supportive nasal framework and provide the aesthetic improvements typically associated with procedures to correct saddle nose deformities. DESIGN, SETTING, AND PARTICIPANTS This algorithm presents septal support reconstruction of patients with saddle nose deformity based on the experience of the senior author in 206 patients with saddle nose deformity. Preoperative examination, intraoperative assessment, reconstruction techniques, graft materials, and patient evaluation of aesthetic success were documented, and 4 different types of saddle nose deformities were defined. MAIN OUTCOMES AND MEASURES The Cakmak algorithm classifies varying degrees of saddle nose deformity from type 0 to type 4 and helps identify the most appropriate surgical procedure to restore the supportive nasal framework and aesthetic dorsum. RESULTS Among the 206 patients, 110 women and 96 men, mean (range) age was 39.7 years (15-68 years), and mean (range) of follow-up was 32 months (6-148 months). All but 12 patients had a history of previous nasal surgeries. Application of the Cakmak algorithm resulted in 36 patients categorized with type 0 saddle nose deformities; 79, type 1; 50, type 2; 20, type 3a; 7, type 3b; and 14, type 4. Postoperative photographs showed improvement of deformities, and patient surveys revealed aesthetic improvement in 201 patients and improvement in nasal breathing in 195 patients. Three patients developed postoperative infection and 21 patients underwent revision septal surgery. CONCLUSIONS AND RELEVANCE The goal of saddle nose reconstruction should be not only to restore an aesthetic dorsum but also to restore the supportive nasal framework. The surgeon should provide more projected and strengthened septal support before augmentation of saddle nose deformity to improve breathing and achieve a stable long-term result. The Cakmak algorithm is a mechanism that helps surgeons identify the most effective way to maximize septal support and aesthetic appeal. LEVEL OF EVIDENCE 4.

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Reconstruction of significant saddle nose deformity using autogenous costal cartilage graft with incorporated mirror image spreader grafts

Cited by 15 publications

References 20 publications

3 The Use of Costal Cartilage for Dorsal Augmentation and Tip Grafting

3 The Use of Costal Cartilage for Dorsal Augmentation and Tip Grafting

Dorsocaudal reconstruction of previous caudal septal resections with partial split spreader graft

Identifying Septal Support Reconstructions for Saddle Nose Deformity

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