Straightening the crooked middle third of the nose, a deformity that compromises both appearance and the airway, can be a significant reconstructive challenge, according to background information in the article. The overlying skin and the tissue just beneath the skin are very thin, exposing any irregularity. The underlying structure is springy and difficult to straighten. In addition, the author notes, any crookedness left after surgery is visually obvious to the patient.
Martyn Mendelsohn, M.B., B.S., F.R.A.C.S., of the Royal Prince Alfred Hospital, Sydney, Australia, reviewed 41 cases of rhinoplasty (plastic surgery of the nose), 26 men and 15 women, in which he used a high density porous polyethylene (HDPP) graft to structurally reinforce the nose. Twenty of the cases were repeat surgeries, the crookedness resulting from previous rhinoplasty. The graft material provides increased strength against further trauma and provides more stability than previous techniques, according to the author.
All 41 patients undergoing surgery with this technique, called extended spreader graft, had substantial improvement in the straightening of the middle third of the nose. One case showed improvement in the airway as well. Follow-up ranged from six months to two years. Results were documented by facial photography of frontal, lateral and base views and were assessed by an unbiased judge who was not informed of the pre- and post-operative status of the patients in the photographs. There were no cases of infection.
"This procedure is safe, effective, and reliable," the author concludes. "The use of porous polyethylene grafts ensures that an ideal graft size and shape can be used regardless of the amount or quality of septal cartilage [underlying structure] available. It leaves the external nose straight, smooth, and strong to reduce the effects of future scar contracture or trauma."
(Arch Facial Plast Surg. 2005; 7:74-80. Available post-embargo at www.archfacial.com.)
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