Decision making in nasal implantations by autogenous, synthetic, or mixed implant units: surgeons and patients needs...

Choosing the best nasal implant is an important issue that is still debated, and no implant is ideal. Hence, a protocol to help surgeons choose the best implant for a specific nasal problem is needed. Such a protocol should consider the needs of the patient and the surgeon, the best outcomes, and the satisfaction of both the patient and the surgeon. Rhinoplasties performed on 32 patients in this study involved three implant types: autogenous, synthetic, and mixed. Observational data were collected to determine the technical needs of patients and surgeons and to evaluate their respective satisfaction using an interpretive score ranging from 0 to 2. Autogenous implant was the most commonly used technique, which included filling volume deficiencies; synthetic implants were used to camouflage irregularities, to pad bony edges, or in nasal tip surgeries; and the mixed implants were used in all surgeries, including covering open roofs or fine-surface irregularities. Acceptable long-term effects and best quality of the results were 100% for mixed implant units, 87.5% for synthetic implants, and 73% for autogenous grafts. Surgeon satisfaction was greatest when patients were most satisfied (score=2), and surgeon satisfaction was significantly lower when patients were dissatisfied (in cases with complications). Choosing the best implant is difficult; many implant types are applicable for more than on purpose, and a specific implant may be more advantageous in a specific case. Considering many factors involved, an algorithm useful for choosing the appropriate implant type is presented.