Skip to main content

Saddle-Nose Deformity Repair with Microplate-Adapted Costal Cartilage

Abstract

Nasal deformities affecting the bone and lower two-thirds of the nose due to the loss of septal height and tip support are defined as “saddle-nose” deformity. Reconstruction of a saddle-nose deformity essentially necessitates structural grafting. This article presents an alternative approach for correction of saddle-nose deformity using a microplate and costal cartilage. The results are compared with those of the previously applied costal cartilage repair methods. Between 2004 and 2013, 16 patients were treated with costal cartilage autografts. Of these 16 patients, 7 were treated with a microplate and costal cartilage autograft combination, 4 were treated with a costal cartilage autograft and Kirschner (K)-wire, and 5 were treated with onlay costal cartilage grafts. The mean follow-up periods were 16 months for group treated with microplate-adapted autologous costal cartilage, 12 months for the group treated with K-wire and autologous costal cartilage, and 16 months for the group treated with onlay costal cartilage. The patients treated with K-wire inserted cartilages and the patients treated onlay dorsal costal cartilages encountered complications such as extrusion of the wire and warping, respectively. The seven patients treated with microplate and dorsal onlay costal cartilage graft did not experience any infection, warping, or extrusion complication. The warping tendency of the costal cartilage autograft can be efficiently prevented without a prominent complication risk by using microplate-adapted costal cartilage grafts.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14

References

  1. Ahmed A, Imani P, Vuyk HD (2010) Reconstruction of significant saddle-nose deformity using autogenous costal cartilage graft with incorporated mirror image spreader grafts. Laryngoscope 120:491–494

    PubMed  Article  Google Scholar 

  2. Andrade M, Fernandes VS, Boléo-Tomé JP (1999) Saddle nose: our approach to the problem. Aesthet Plast Surg 23:403–406

    CAS  Article  Google Scholar 

  3. Young K, Rowe-Jones J (2011) Current approaches to septal saddle-nose reconstruction using autografts. Curr Opin Otolaryngol Head Neck Surg 19:276–282

    PubMed  Article  Google Scholar 

  4. Sajjadian A, Rubinstein R, Naghshineh N (2010) Current status of grafts and implants in rhinoplasty: part I. Autologous grafts. Plast Reconstr Surg 125:40e–49e

    PubMed  Article  Google Scholar 

  5. Sajjadian A, Naghshineh N, Rubinstein R (2010) Current status of grafts and implants in rhinoplasty: part II. Homologous grafts and allogenic implants. Plast Reconstr Surg 125:99e–109e

    CAS  PubMed  Article  Google Scholar 

  6. Al-Qattan MM (2007) Augmentation of the nasal dorsum with autogenous costal cartilage using the “edge-on” technique. Ann Plast Surg 59:642–644

    CAS  PubMed  Article  Google Scholar 

  7. Daniel RK (1994) Rhinoplasty and rib grafts: evolving a flexible operative technique. Plast Reconstr Surg 94:597–609

    CAS  PubMed  Article  Google Scholar 

  8. Gibson T, Davis WB (1958) The distortion of autogenous cartilage grafts: its cause and prevention. Br J Plast Surg 10:257–274

    Article  Google Scholar 

  9. Adams WP Jr, Rohrich RJ, Gunter JP, Clark CP, Robinson JB Jr (1999) The rate of warping in irradiated and non-irradiated homograft rib cartilage: a controlled comparison and clinical implications. Plast Reconstr Surg 103:265–270

    PubMed  Article  Google Scholar 

  10. Ozturan O, Aksoy F, Veyseller B, Apuhan T, Yıldırım YS (2013) Severe saddle nose: choices for augmentation and application of accordion technique against warping. Aesthet Plast Surg 37:106–116

    Article  Google Scholar 

  11. Gunter JP, Clark CP, Friedman RM (1997) Internal stabilization of autogenous rib cartilage grafts in rhinoplasty: a barrier to cartilage warping. Plast Reconstr Surg 100:161–169

    CAS  PubMed  Article  Google Scholar 

  12. Sheen JH (1998) The ideal dorsal graft: a continuing quest. Plast Reconstr Surg 102:2490–2493

    CAS  PubMed  Article  Google Scholar 

  13. Sheen JH (1993) Tip graft: a 20-year retrospective. Plast Reconstr Surg 91:48–63

    CAS  PubMed  Article  Google Scholar 

  14. Endo T, Nakayama Y, Ito Y (1991) Augmentation rhinoplasty: observations on 1,200 cases. Plast Reconstr Surg 87:54–59

    CAS  PubMed  Article  Google Scholar 

  15. Jensen J, Sindet-Pedersen S, Christensen L (1992) Rigid fixation in reconstruction of craniofacial fractures. J Oral Maxillofac Surg 50:550–554

    CAS  PubMed  Article  Google Scholar 

  16. Evans GR, Clark N, Manson PN, Leipziger LS (1995) Role of mini- and microplate fixation in fractures of the midface and mandible. Ann Plast Surg 34:453–456

    CAS  PubMed  Article  Google Scholar 

  17. Champy M, Blez P (2009) Anatomical aspects and biomechanical considerations. In: Haerle F, Champy M, Terry B (eds) Atlas of craniomaxillofacial osteosynthesis: microplates, miniplates, and screws. Thieme, New York, pp 1–7

    Google Scholar 

Download references

Conflicts of interest

The authors declare that they have no conflicts of interest to disclose.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Sinan Öksüz.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Eren, F., Öksüz, S., Melikoğlu, C. et al. Saddle-Nose Deformity Repair with Microplate-Adapted Costal Cartilage. Aesth Plast Surg 38, 733–741 (2014). https://doi.org/10.1007/s00266-014-0344-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00266-014-0344-0

Keywords

  • Costal cartilage
  • Microplate
  • Saddle nose