Saddle-Nose Deformity Repair with Microplate-Adapted Costal Cartilage

Eren, Fi̇kret; Öksüz, Si̇nan; Melikoglu, Cenk; Karagöz, Hüseyi̇n; Ülkür, Ersi̇n

doi:10.1007/s00266-014-0344-0

Cited by 16 publications

(14 citation statements)

References 16 publications

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“…20 Eren reported warping in 5 out of 5 patients with an unstabilized dorsal strut. 10 Hyun's more extensive study of 45 patients who received autologous or homogenous costal grafts reported a 2% warping rate when one of three cartilage configurations were used. 4 The pi graft borrows from preexisting techniques to correct the saddle nose deformity.…”

Section: Discussionmentioning

confidence: 99%

“…21 Elaborate strategies to prevent warping include harvest of bone graft and reinforcement with Kirschner wires, laminate construction, microplates, chimeric autologous graft, or crossbar grafts. 10,11,13,15,22,23 The authors feel that a simpler approach is to fixate the dorsal strut at a second point. The pi graft was designed with a structural engineer's mindset: the second strut is intended to (1) reduce the moment arm on the nasal-graft junction and (2) provide a third point of fixation, on the opposite side of the caudal strut, to minimize lateral warping.…”

Section: Discussionmentioning

confidence: 99%

“…4 Because warping can occur and often is a cause for surgical revision with costal cartilage, many strategies have evolved to prevent or correct that deformity. [9][10][11][12][13][14] Recurrence is another reported complication of saddle nose deformity. If the keystone area is destabilized or the caudal septum gives way, the dorsal septum or graft may buckle.…”

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confidence: 99%

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The Pi Graft for Correction of Severe Saddle Nose Deformity

Zelken¹,

Chang

Hsiao

2016

Facial plast Surg

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Saddle nose deformity is challenging because there is both aesthetic and functional compromise, and high rates of recurrence have been reported. Autologous costal cartilage is the widely preferred medium for reconstruction, but there may be room for improvement in the configuration of the cartilage struts. The pi graft is stabilized at two points, proximally and distally, distinguishing it from the traditional L-strut. Indications include severe (Types III and IV) saddle nose deformity with collapse of the mid-vault, and recurrence after prior reconstruction. Costal cartilage is harvested and three struts are crafted to make the foundation layer: a dorsal strut, caudal strut, and mid-vault strut. An aesthetic layer is composed of a carefully crafted dorsal graft and tip graft. Three men and 11 women were treated from 2013 to 2015 using this method for severe saddle nose deformity. Aesthetic and functional outcomes were evaluated. Patients were followed up for 12 months (range, 8-14 months). There was no recurrence of deformity or warping of the aesthetic or foundation layers. All patients were guided to anticipate refinement of the tip at 3 months to ease the burden on the skin envelope in stage I, but only five patients (35.7%) opted for it, as the remaining patients were satisfied with their appearance. The pi graft is a composite reconstructive method that is designed to minimize warping and recurrence of the saddle nose deformity. This method was successful in this series, although objective comparisons with traditional methods were not made.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Pi Graft for Correction of Severe Saddle Nose Deformity

Zelken¹,

Chang

Hsiao

2016

Facial plast Surg

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“…These patients are often treated with cantilevered dorsal grafts of various materials. 6,[15][16][17] However, the main reason for the depression of nasal dorsum is weakening of the septal skeleton, which if not reestablished, cannot produce a functional improvement with a simple onlay graft or a cantilevered dorsal graft.…”

Section: Discussionmentioning

confidence: 99%

“…2 Previous studies focusing on the aesthetic feature of this deformity have contended the need for onlay grafts to restore the normal appearance of the nasal dorsum. Although different materials and the fixation techniques have their own advantages and disadvantages, [3][4][5][6] the absence of addressing septal support has been a major pitfall.…”

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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