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Facial Plast Surg 2016; 32(04): 452-459
DOI: 10.1055/s-0036-1584555
Rapid Communication
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Pi Graft for Correction of Severe Saddle Nose Deformity

Jonathan Zelken
1   Private Practice, Newport Beach, California
,
Chun-Shin Chang
2   Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan
,
Yen-Chang Hsiao
2   Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan
› Author Affiliations
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Publication History

Publication Date:
05 August 2016 (online)

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Abstract

Saddle nose deformity is challenging because there is both aesthetic and functional compromise, and high rates of recurrence have been reported. Autologous costal cartilage is the widely preferred medium for reconstruction, but there may be room for improvement in the configuration of the cartilage struts. The pi graft is stabilized at two points, proximally and distally, distinguishing it from the traditional L-strut. Indications include severe (Types III and IV) saddle nose deformity with collapse of the mid-vault, and recurrence after prior reconstruction. Costal cartilage is harvested and three struts are crafted to make the foundation layer: a dorsal strut, caudal strut, and mid-vault strut. An aesthetic layer is composed of a carefully crafted dorsal graft and tip graft. Three men and 11 women were treated from 2013 to 2015 using this method for severe saddle nose deformity. Aesthetic and functional outcomes were evaluated. Patients were followed up for 12 months (range, 8–14 months). There was no recurrence of deformity or warping of the aesthetic or foundation layers. All patients were guided to anticipate refinement of the tip at 3 months to ease the burden on the skin envelope in stage I, but only five patients (35.7%) opted for it, as the remaining patients were satisfied with their appearance. The pi graft is a composite reconstructive method that is designed to minimize warping and recurrence of the saddle nose deformity. This method was successful in this series, although objective comparisons with traditional methods were not made.

Keywords

saddle nose - rhinoplasty - nasal reconstruction
 

  • References

  • 1 Cakmak O, Emre IE, Ozkurt FE. Identifying septal support reconstructions for saddle nose deformity: the Cakmak algorithm. JAMA Facial Plast Surg 2015; 17 (6) 433-439
    CrossrefPubMedGoogle Scholar
  • 2 Daniel RK. Rhinoplasty: septal saddle nose deformity and composite reconstruction. Plast Reconstr Surg 2007; 119 (3) 1029-1043
    CrossrefPubMedGoogle Scholar
  • 3 Durbec M, Disant F. Saddle nose: classification and therapeutic management. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131 (2) 99-106
    CrossrefPubMedGoogle Scholar
  • 4 Hyun SM, Jang YJ. Treatment outcomes of saddle nose correction. JAMA Facial Plast Surg 2013; 15 (4) 280-286
    CrossrefPubMedGoogle Scholar
  • 5 Kim DW, Toriumi DM. Management of posttraumatic nasal deformities: the crooked nose and the saddle nose. Facial Plast Surg Clin North Am 2004; 12 (1) 111-132
    CrossrefPubMedGoogle Scholar
  • 6 Stuzin JM, Kawamoto HK. Saddle nasal deformity. Clin Plast Surg 1988; 15 (1) 83-93
    PubMedGoogle Scholar
  • 7 Tardy Jr ME, Schwartz M, Parras G. Saddle nose deformity: autogenous graft repair. Facial Plast Surg 1989; 6 (2) 121-134
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Young K, Rowe-Jones J. Current approaches to septal saddle nose reconstruction using autografts. Curr Opin Otolaryngol Head Neck Surg 2011; 19 (4) 276-282
    CrossrefPubMedGoogle Scholar
  • 9 Bhat U, Garg S, D'Souza EJ, Agarkhedkar N, Singh IA, Baliarsing AS. Precision carving of costal cartilage graft for contour fill in aesthetic and reconstructive rhinoplasty. Indian J Plast Surg 2014; 47 (1) 25-35
    CrossrefPubMedGoogle Scholar
  • 10 Eren F, Öksüz S, Melikoğlu C, Karagöz H, Ülkür E. Saddle-nose deformity repair with microplate-adapted costal cartilage. Aesthetic Plast Surg 2014; 38 (4) 733-741
    CrossrefPubMedGoogle Scholar
  • 11 Gunter JP, Clark CP, Friedman RM. Internal stabilization of autogenous rib cartilage grafts in rhinoplasty: a barrier to cartilage warping. Plast Reconstr Surg 1997; 100 (1) 161-169
    CrossrefPubMedGoogle Scholar
  • 12 Ozturan O, Aksoy F, Veyseller B, Apuhan T, Yıldırım YS. Severe saddle nose: choices for augmentation and application of accordion technique against warping. Aesthetic Plast Surg 2013; 37 (1) 106-116
    Google Scholar
  • 13 Swanepoel PF, Fysh R. Laminated dorsal beam graft to eliminate postoperative twisting complications. Arch Facial Plast Surg 2007; 9 (4) 285-289
    CrossrefPubMedGoogle Scholar
  • 14 Taştan E, Yücel OT, Aydin E, Aydoğan F, Beriat K, Ulusoy MG. The oblique split method: a novel technique for carving costal cartilage grafts. JAMA Facial Plast Surg 2013; 15 (3) 198-203
    CrossrefPubMedGoogle Scholar
  • 15 Aziz ZS, Brenner MJ, Putman III HC. Oblique septal crossbar graft for anterior septal angle reconstruction. Arch Facial Plast Surg 2010; 12 (6) 422-426
    PubMedGoogle Scholar
  • 16 Byrd HS, Andochick S, Copit S, Walton KG. Septal extension grafts: a method of controlling tip projection shape. Plast Reconstr Surg 1997; 100 (4) 999-1010
    CrossrefPubMedGoogle Scholar
  • 17 Jung DH, Chang GU, Shan L , et al. Pressure necrosis of septal cartilage associated with bilateral extended spreader grafts in rhinoplasty. Arch Facial Plast Surg 2010; 12 (4) 257-262
    PubMedGoogle Scholar
  • 18 Jung DH, Loh I. The “X-graft” for nasal tip surgery. Plast Reconstr Surg 2011; 128 (2) 79e-80e
    CrossrefPubMedGoogle Scholar
  • 19 Ahmed A, Imani P, Vuyk HD. Reconstruction of significant saddle nose deformity using autogenous costal cartilage graft with incorporated mirror image spreader grafts. Laryngoscope 2010; 120 (3) 491-494
    CrossrefPubMedGoogle Scholar
  • 20 Qian SY, Malata CM. Avoiding pitfalls in open augmentation rhinoplasty with autologous L-shaped costal cartilage strut grafts for saddle nose collapse due to autoimmune disease: the Cambridge experience. J Plast Reconstr Aesthet Surg 2014; 67 (8) e195-e203
    CrossrefPubMedGoogle Scholar
  • 21 Davis WB, Gibson T. Absorption of autogenous cartilage grafts in man. Br J Plast Surg 1956; 9 (3) 177-185
    CrossrefPubMedGoogle Scholar
  • 22 Shipchandler TZ, Chung BJ, Alam DS. Saddle nose deformity reconstruction with a split calvarial bone L-shaped strut. Arch Facial Plast Surg 2008; 10 (5) 305-311
    CrossrefPubMedGoogle Scholar
  • 23 Hsiao YC, Abdelrahman M, Chang CS , et al. Chimeric autologous costal cartilage graft to prevent warping. Plast Reconstr Surg 2014; 133 (6) 768e-775e
    CrossrefPubMedGoogle Scholar
  • 24 Won TB, Kang JG, Jin HR. Management of post-traumatic combined deviated and saddle nose deformity. Acta Otolaryngol 2012; 132 (Suppl. 01) S44-S51
    CrossrefPubMedGoogle Scholar