Management of Saddle Nose Deformity Using Dermal Fat and Costal Cartilage “Sandwich” Graft: A Problem-Oriented Approach and Anthropometrical Evaluation

Publication date: Available online 20 May 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Onder Tan, Said Algan, Hakan Cinal, Ensar Zafer Barin, Murat Kara, Akin Inaloz
PurposeIn surgical treatment of Saddle nose deformity (SND), costal cartilage is often used, but has some potential complications such as resorption, bending, displacement and appearance under the skin (silhouette deformity). We prepared a composite "sandwich" graft by camouflaging the costal cartilage underneath the dermal fat graft as a novel method and applied it on the SNDs with the closed rhinoplasty technique to prevent or minimize these risks.MethodsThe method was applied on 21 patients (12 males and 9 females). Six anthropometrical measurements including nasal dorsum projection, nasal supratip projection, nasal tip projection, nose length, labio-columellar angle and naso-frontal angle were performed by using Image J^TM program on preoperative and postoperative lateral photographs. Data were compared statistically.ResultsThe mean follow-up time was 29,95 months. No donor site complication was encountered. Sandwich grafts transferred to the nose were well tolerated in all patients. A partial graft failure and a mild bending, which were treated conservatively without supplemental surgery, developed in one each patient. No resorption, migration, bending or appearance under the skin of the sandwich grafts were seen in the remaining patients. There was a statistically difference in all anthropometrical measurements of the preoperative and postoperative groups except two.ConclusionSeverity of the deformity should be exactly determined prior to operation and cartilage grafts should be used accordingly for a successful repair of SND. The "sandwich" technique, as a practical, effective and long lasting treatment method may minimize the potential complications and revision risks.



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