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

ABSTRACT

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.