Immediate reconstruction of extruded alloplastic nasal implants with irradiated homograft costal cartilage.
ABSTRACT To describe a novel surgical protocol for the management of patients presenting with extruded nasal implants.
Retrospective chart review.
Analysis of consecutive patients presenting with extruded nasal implants from 1986 to 2000. Patients were selected from a large database of revision rhinoplasty cases. Inclusion criteria were: 1) at least one previous rhinoplasty procedure, 2) an extruded nasal implant that was documented preoperatively, 3) immediate reconstruction that was carried out with irradiated homograft costal cartilage (IHCC), and 4) at least 1 year of follow-up recorded, including standard postoperative rhinoplasty photographs. A total of 18 patients met the inclusion criteria and form the basis of this study. Data gathered from the charts included date of surgery, last date of follow-up, location of implant extrusion, alloplastic material, specific use of IHCC for reconstruction, percent of clinical IHCC resorption at last follow-up, and presence of warping of the IHCC.
All 18 patients were satisfied with the cosmetic outcomes of their nasal reconstructions. The most common extruded alloplast was Silastic, followed by Gore-Tex (W.L. Gore & Associates, Inc., Flagstaff, AZ). There were no cases of extrusion or infection of the IHCC implant subsequent to immediate reconstruction of the extruded alloplast. Clinical resorption of the IHCC was minimal, with a mean follow-up of 26 months. Only one patient had a complication, warpage, resulting in removal of the IHCC. In that patient, the IHCC still had carving markings on the implant after 2 years in vivo.
In this series of patients, a novel surgical protocol was used. The extruded implant was removed and immediate reconstruction with irradiated rib cartilage was done. All patients were evaluated for postoperative infection, graft extrusion, and satisfaction with cosmetic result. There was one major complication in this series of 18 patients, warping of the IHCC, which necessitated removal and replacement. This approach appears to be a reasonable method for reconstruction of extruded nasal alloplasts.
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ABSTRACT: Postoperative rhinoplasty deformities--such as displacement or distortion of anatomic structures, inadequate surgery resulting in under-resection of the nasal framework, or over-resection caused by overzealous surgery--require a secondary rhinoplasty. Success in secondary rhinoplasty, therefore, relies on an accurate clinical diagnosis and analysis of the nasal deformities, a thorough operative plan to address each abnormality, and a meticulous surgical technique. Septal cartilage is the grafting material of choice for rhinoplasty; however, auricular cartilage and rib cartilage are used in secondary rhinoplasty. This article discusses the steps involved in the external approach to secondary rhinoplasty.Clinics in plastic surgery 04/2010; 37(2):371-82. · 0.95 Impact Factor
Article: Complications of rhinoplasty.[show abstract] [hide abstract]
ABSTRACT: Rhinoplasty presents a unique set of challenges for the cosmetic surgeon. Complications may arise from inadequate diagnosis, errors in surgical technique, or variations in the patient's anatomy or healing response. Complications as a result of overly aggressive surgery may also have functional consequences and be harder to correct.Oral and maxillofacial surgery clinics of North America 03/2009; 21(1):81-9, vi.
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