Saddle nose deformity reconstruction with a split calvarial bone L-shaped strut

Area of Science:

• Plastic Surgery
• Otolaryngology
• Reconstructive Surgery

Background:

• Substantial septal saddle nose deformities often result from inflammatory conditions, trauma, or surgical resection.
• Existing reconstructive techniques may have limitations in providing both dorsal support and tip projection, especially in compromised vascular beds.

Observation:

• A split calvarial bone L-shaped strut technique was utilized for nasal reconstruction in fifteen patients.
• The technique was applied to cases with deformities caused by cocaine use, infection, sarcoidosis, malignancy, iatrogenic factors, and Wegener granulomatosis.

Findings:

• The L-shaped strut successfully augmented and straightened the nasal dorsum while increasing tip projection in all cases.
• Follow-up to 36 months showed maintained results with no evidence of graft infection, resorption, or migration.
• The technique was performed via an external rhinoplasty approach, avoiding radix or intranasal mucosal incisions.

Implications:

• The split calvarial bone L-shaped strut offers a dual benefit of dorsal support and tip projection for nasal reconstruction.
• This technique demonstrates long-term graft stability, even in patients with compromised vascularity due to inflammatory diseases.
• The described approach provides an effective solution for complex saddle nose deformities, regardless of etiology or defect duration.