Article

Calvarial bone grafts for augmentation rhinoplasty

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Abstract

A large variety of graft materials have been used for augmentation rhinoplasty. To date there has been no graft material which can be regarded as completely satisfactory. The modern trend is to prefer autologous material to new biological material. The membranous bones of the calvarium are extremely suitable for augmenting moderate to severe saddle nose deformities. Calvarial bone grafts can be harvested easily, with minimum donor site morbidity and disfigurement. Our experience with calvarial bone grafts for augmentation rhinoplasty is presented.

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Article
Several types of grafts and materials are used in rhinoplasty: implant (polyethylene, metilmetacrilate, silicon, Supramide, Proplast, politetrafluoretilene, Dacron, Gore-Tex), homologous and autologous cartilage, etc. We present a historical and updated revision of the grafts in the plastic surgery of the nose. An ideal graft, for all the areas of the nose, doesn't exist. The appropriate material is chosen in agreement with the surgeon's preference, based on the characteristic of that and on the surgical needs. It is in research the production, in laboratory, of cartilaginous tissue for transplants to be used in the completion of defects of the face. That is future.
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Article
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Article
A review of a new technique for the harvesting of split (outer-table) calvarial bone grafts is presented. The use of calvarial bone grafts for facial reconstructive surgery has become more commonplace in recent years. Low donor site morbidity and availability of adequate amounts of membranous bone in close proximity to the facial surgical site make its use particularly desirable. Unfortunately, the occasional complications associated with the harvesting of these grafts can be severe, including dural tears and/or hemorrhage from a dural sinus, as well as late hematomas and meningitis. The technique herein described involves the use of a long malleable blade in a reciprocating saw. The malleability of the blade allows it to conform to the shape of the skull while elevating split grafts almost as wide as the blade is long. Twenty separate grafts were harvested in 18 patients. The largest measured 7 x 10 cm. The grafts were further contoured after harvesting and used in 37 sites. No grafts splintered, and no donor site complications were encountered. While care must of course be exercised with any technique, this one is believed to be a safe and dependable method for the harvesting of split calvarial grafts for facial reconstruction.
Article
Nasal reconstruction may best be carried out with bone grafting in certain cases of loss of structural support. In order to optimize both the aesthetic and functional results of bone-graft nasal reconstruction, we studied the shape and thickness of the normal human nasal bone. Sixty Caucasian skull nasal bones were measured by width throughout their length at three planes of depth. Seventeen Caucasian cadaver nasal bones were examined to determine the thickness of the bone throughout its length at three sagittal planes. The results showed that the nasal bone was widest at the nasofrontal suture (14 mm), narrowest at the nasofrontal angle (10 mm), and then widened again to a maximum width of 12 mm about 9 to 12 mm inferior to the nasofrontal angle. The nasal bone was thickest superiorly at the nasofrontal angle (average 6 mm) and progressively thinned toward the tip. It was 3 to 4 mm thick in the critical area where screws are most commonly placed for fixation (5 to 10 mm inferior to the nasofrontal angle). From these data, three-dimensional models of the normal nasal bone shape were formulated and used in clinical bone-graft cases.
Article
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Article
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Article
Reconstruction of nasal contour where skeletal support is deficient or absent has usually been achieved using autogenous bone. Membranous bone taken from the cranium is clearly superior to rib or iliac crest when used as autografting material to the craniofacial skeleton. Conventionally, the bone graft is rigidly fixated to the recipient nasal bone with either metal plate-screw systems or Kirschner wires. Reported here are the results of a single biodegradable screw fixation of the split calvarial graft that is used for nasal reconstruction. Ten patients with moderate to severe saddle nose deformity underwent reconstruction using the open rhinoplasty approach. The graft was harvested from the outer cortex of the parietal bone, shaped, and secured in place with a single bioresorbable screw. No significant resorption has been observed in the grafts and a favorable aesthetic result was achieved in all of the cases. Described modification in fixation of the bone graft in nasal reconstruction avoids some of the disadvantages of permanent materials while preserving the advantages of rigid fixation.
Article
1.Autogenous cartilage as a grafting material for nasal bridge reconstruction has largely fallen into disuse because of the high incidence of distortion. An analysis of ninety-one of Professor T. P. Kilner's cases showed that about two-thirds warped to some extent within one or two weeks after operation, although the grafts had been freed from fibrous perichondrium before insertion.2.Experiments in vitro demonstrated that in rib cartilage a state of tension exists in which the taut outer layer of cartilage acts as a "skin" which controls the tendency of the main mass to expand.3.Distortion results from the contraction of the outer layer when the rib is so carved that the natural equilibrium is upset. In this the fibrous perichondrium plays little or no part.4.The "principle of the balanced cross-section" has been introduced: if the distorting forces are balanced at all points along a cartilage graft as viewed in cross-section it will not warp.5.Applying this principle, methods are detailed whereby stable grafts for nasal bridge reconstruction may be obtained.6.Although the amount of carving permissible is limited, the shape and size of the costal margin cartilages are peculiarly suitable for nasal bridge grafts.7.Forty-six grafts, carved according to the principle of the balanced cross-section, have been inserted during the past three years, and none has become distorted.8.When used as described, autogenous rib cartilage is considered to be the material of choice in nasal bridge restoration.
Article
Correction of a saddle nose deformity due to atrophic rhinitis is a formidable task. The thick and puckered skin secondary to long standing disease makes the creation of a dorsal subdermal pocket difficult. On the one hand, these patients tolerate synthetic implants poorly and on the other they show an unusually high rate of absorption of autologous bone graft. Our experience of treating 15 patients with saddle nose deformity secondary to atrophic rhinitis is presented.
Article
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Article
Augmentation rhinoplasties in our clinic were surveyed for complications during the five years 1974 to 1978. Our finding of three main complications--malposition, a too-large or too-high prosthesis, and perforation--is reported here. Prevention of such complications is also discussed.
Umbrella grafting for nasal tip augmentation
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