Bony Deformity after Augmentation Rhinoplasty with Silicone Implant

Silicone implants for augmentation rhinoplasty have been used by many surgeons over the past few decades. However, no clinical evaluation of the nasal bones beneath the silicone implant has been conducted to date. Between 2010 and 2012, we reviewed patients' facial computed tomography scans and finally selected 13 patients according to the exclusion criteria. To evaluate the extent of bone resorption, we measured the angle (theta) of the deformed portion. And we measured the thickness of nasal bones to evaluate the bony resorption.A total of 13 patients had some evidence of bone resorption or bony deformity on their computed tomography. An evaluation of the CT scan of the nasal bones showed deformity of the bones underneath the implant. The bones had lost the dome shaped convexity and showed flat configuration under the implant. The values of the angle (theta) ranged from 45to 75 degrees (mean 58.1 degree). The thickness of nasal bone showed statistically significant results at the tip of bony vault. This study has demonstrated of bone deformation beneath the silicone implants in humans.

Fixation of Nasal Bone Fracture with Carved Merocel(R)

PURPOSE: In most cases of nasal bone fracture, closed reduction with internal or external splint fixation approach is selected. However, because of indiscriminate insertion of the internal splint without considering of anatomical difference or deformity, insufficient fixation happens frequently that need additional fixation. Therefore, we suggest a new method for providing adequate support in reduced nasal bone by carving Merocel(R) that is fixed for the anatomical structure. METHODS: Closed reduction and internal fixation with carved Merocel(R) was performed in 15 nasal bone fracture patients from March, 2010 to July, 2010. Each patient was evaluated by physical examination, facial photographic check, simple X-ray, and computerized tomography. On the first day post-operation, location of packing and amount of reduction were checked by follow up X-ray and computerized tomography. In addition, patients' symptoms were evaluated. During the 3-month post-op follow up at out-patient clinic, operator, 2 doctors in training and one assistant performed the objective evaluations by physical examination on nasal dorsal hump, nasal deviation, nasal depression, nasal breath difficulty, and nasal airway obstruction. A survey of subjective patients' satisfaction in 4-stages was also performed. RESULTS: The results of follow-up computerized tomography of the 15 patients revealed that 11 patients had good reduced state. Three patients with combined maxillary frontal process fracture had over reductions. A survey performed on the first day post-operation showed that 14 of 15 patients answered that their current symptoms were more than tolerable. At the 3-month follow-up physical exam, one case had a dorsal hump. However, there were no nasal deviations, nasal depressions, nasal breath difficulties, or nasal airway obstructions. Twelve of the 15 patients answered more than moderate on the 3-month survey. CONCLUSION: Intranasal packing after carving the Merocel(R) considering anatomical structure is a new effective method to promote proper-reduction, maintain stability, and minimize patients' symptoms by addition of a simple procedure.