Effectiveness of comprehensive rhinoplasty on secondary nasal deformity with saddle nasal deformity after cleft lip surgery / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of comprehensive rhinoplasty with autogenous costal cartilage grafting and prosthesis augmentation rhinoplasty in the treatment of secondary nasal deformity with saddle nasal deformity after cleft lip surgery.@*METHODS@#The clinical data of 96 patients with secondary nasal deformity with saddle nasal deformity after cleft lip surgery between September 2008 and January 2019 were retrospectively analyzed. There were 17 males and 79 females with an average age of 25.6 years (range, 17-38 years). Autogenous costal cartilage grafts were used to construct stable nasal tip framework and enhance the strength of alar cartilage. Nasal dorsum prostheses (39 cases of bulge, 45 cases of silicone prosthesis) or autogenous costal cartilage (12 cases) were used for comprehensive rhinoplasty. Visual analogue scale (VAS) score was used to evaluate the postoperative satisfaction subjectively, and nasal alar height symmetry index, nasal alar width symmetry index, nasal dorsum central axis deviation angle, and nasal columella deviation angle were calculated to evaluate objectively before and after operation.@*RESULTS@#All patients were followed up 6 months to 8 years, with an average of 13.4 months. Nasal septal hematoma occurred in 3 patients after operation, which was improved after local aspiration and nasal pressure packing. Two cases had mild deformation of the rib cartilage graft of the nasal dorsum, one of which had no obvious deviation of the nasal dorsum and was not given special treatment, and one case underwent the cartilage graft of the nasal dorsum removed and replaced with silicone prosthesis. The incisions of the other patients healed by first intention, and there was no complication such as postoperative infection and prosthesis displacement. The nasal alar height symmetry index, nasal alar width symmetry index, nasal dorsum central axis deviation angle, and nasal columella deviation angle significantly improved after operation when compared with preoperative ones ( P<0.05). Postoperative subjective satisfaction evaluation reached the level of basic satisfaction or above, and most of them were very satisfied.@*CONCLUSION@#Comprehensive rhinoplasty using autologous rib cartilage grafting to construct a stable nasal tip support, combined with dorsal nasal prosthesis or autologous cartilage implantation, can achieve good effectiveness on secondary nasal deformity with saddle nasal deformity after cleft lip surgery.

Early intervention following an unusual late complication of cantilever nasal costochondral grafts

The concept of the cantilever bone graft, popularised by Millard (1966), and its subsequent modification by Chait et al. (1980), led to the idea of the costochondral cantilever graft for nasal dorsum augmentation. Over 150 costochondral nasal grafts have been performed at the Australian Craniofacial Unit (ACFU) over the last 25 years, and the aim of this study was to review a cohort of fractured costochondral graft in patients treated at the ACFU. The notes of patients with nasal costochondral grafts were reviewed, those with a fractured graft forming the basis of this study. Patients with Binder Syndrome accounted for nearly 30% of the cohort. Other diagnoses included Opitz syndrome, frontonasal dysplasia and other craniofacial abnormalities. 3 patients were identified with late fractured costochondral grafts. The prominent position of the nose makes it easily susceptible to trauma, and very often, low energy impact can produce fractures of the nasal bones. To the best of our knowledge, this is the first reported series of fractures of costochondral nasal grafts and their subsequent management. We would advocate early surgical management of the fractured grafts when conservative treatment has failed. In our present series, all 3 patients still maintained a satisfactory cosmetic and functional result after a mean of 8.5 years following the reparative surgery.