Extended osteocartilaginous spreader graft for reconstruction of deviated nose.

OBJECTIVE: Correction of a deviated nose is a challenging problem for which different approaches may be considered. This study was designed to introduce a new technique for correction of a deviated nose with a high success rate. STUDY DESIGN: The study was a prospective follow-up of 59 patients with deviated nose who had undergone corrective surgery. SETTING: An extended osteocartilaginous spreader graft was harvested from the quadrangular septum and the perpendicular plate of the ethmoid. After a medial osteotomy that was performed on the concave side, the nasal bone was lateralized and an extended osteocartilaginous spreader graft was inserted between the nasal bone and the septum to prevent further retraction of the concave side due to fibrotic scar tissue. On the contralateral side, a low lateral osteotomy was done as routine. SUBJECTS AND METHODS: The operation was done on the 59 cases with deviated nose. The subjects were followed up during a period of 8 months to 4 years. According to physical examination, postoperative photography, and patients' satisfaction, the final results were categorized as excellent, fair, or poor. RESULTS: Forty-eight patients (81.3%) were categorized as having excellent results. Eight patients (13.6%) showed fair improvement, while the results of surgery in only 3 patients (5.1%) were classified as poor. CONCLUSION: An extended osteocartilaginous spreader graft, with medial osteotomy and lateralization of the nasal bone on the concave side, is a new technique with a high success rate for correction of deviated nose.

A new approach in open rhinoplasty: new alar rim raising technique.

BACKGROUND: The relationship of the alar rim to the columella and its contour has great aesthetic importance, and correcting its deformities is sometimes challenging, especially if it is hanging, asymmetrical, or sigmoid--especially in the African or Asian nose. METHODS: The new method of alar rim incision is described here. This new approach combines the alar rim incision and incisions necessary for external rhinoplasty (modified external approach). RESULTS: All 24 patients noticed improvement and were satisfied with the results. Alar function was preserved in all cases. There were no complications, but two cases had asymmetrical alar width. CONCLUSION: Our new incision for alar rim excision not only decreases incision lines in the limited area of the nose, resulting in decreased risk of tissue compromise, but also provides a controlled method to remove excessive skins of the rim.

Mastoid bone as a new graft material in rhinoplasty.

BACKGROUND: The management of certain nasal deformities, especially after prior rhinoplasty, may require grafting material. In this study we describe the use of mastoid bone as a viable and low morbidity autologous graft. METHODS: Mastoid bone was used for nasal augmentation, smoothing dorsal nasal irregularities, or augmentation of radix. Candidates for mastoid bone graft were patients undergoing primary rhinoplasty suffering from low radix or saddle nose deformity and candidates for secondary rhinoplasty suffering from prior overresection of the osteocartilaginous structures. RESULTS: Fifty-six patients met the study criteria. Eighteen patients underwent secondary rhinoplasty and suffered from prior overresection of osteocartilaginous structures and 38 patients underwent primary rhinoplasty. Of these, 18 patients had a low radix and 20 patients had a saddle nose deformity. Follow-up was 6-49 months (mean, 23 months). All cases resulted in an augmented straightened nasal dorsum, increased tip projection, and adjusted radix. There were no cases of graft infection. In two cases the graft was displaced requiring revision. The amount of graft absorption even after 2 years follow-up was acceptable. There were no donor site complications. CONCLUSIONS: The mastoid bone graft provides adequate autologous bone in most cases of primary or revision rhinoplasty. The donor site carries low morbidity and a well camouflaged scar. It is easily accessible especially for the otolaryngologist who is accustomed to operating on the mastoid bone.