The Role of Split Costochondral Graft in the Restoration of Nasal Dorsum in Post-Traumatic Nasal Deformities

Elbanoby, Tarek M.

doi:10.21608/ejprs.2018.214971

The Role of Split Costochondral Graft in the Restoration of Nasal Dorsum in Post-Traumatic Nasal Deformities

Document Type : Original Article

Author

Tarek M. Elbanoby

The Department of Plastic and Burn Surgery, Faculty of Medicine, Al-Azhar University

10.21608/ejprs.2018.214971

Abstract

Introduction: Rhinoplasty in the treatment of traumatic
nasal deformity remains one of the most challenging problems
for surgeons. Reconstruction of the nasal osseocartilaginous
framework is the foundation of successful rhinoplasty. In this
article, we present our experience in restoration of the dorsum
of the nose in post-traumatic nasal deformities, by carved insitu
split costochondral graft as a new technique to restore
the missing part of the nose.
Patients and Methods: From April 2013 to May 2016, 13
patients, including nine males and four females underwent
augmentation rhinoplasty for the correction of the posttraumatic
nasal deformity. Patients in need of soft tissue
reconstruction were excluded from this study. The nature of
nasal deformities varied between saddle nose, a crooked nose
or combined. The nasal dorsum was restored using the split
costochondral graft. The mean follow-up period after the
surgery was 22 months. Patients’ satisfaction evaluation was
obtained, and the results were analyzed and reported.
Results: A total of 13 rib graft rhinoplasties were performed
in the three-year review period. The mean duration of clinical
follow-up was 22 months. None of the grafts warped. None
of the patients had lost dorsal projection; only one patient has
lost the columellar strut secondary to infection, two of the
patients developed hypertrophic scars, and two of 13 patients
(26%) had revision surgery for minor cosmetic revision.
Conclusion: The fundamental strength of the osseocartilaginous
rib graft lies in replacing like with like. In-situ
splitting of the costochondral graft provides a safe and efficient
method to restore the nasal dorsum. A chimeric bony and
cartilaginous graft allows for bone integration with the nasal
dorsum, preventing mobilization, and allows for subtle sculpting
of the cartilaginous nasal tip.

Keywords

Main Subjects

Aesthetics

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