[Rhinoplasty using the coronal approach after extensive facial skull fractures]

Functional, aesthetically perfect restoration of the face of patients suffering from a severely smashed facial skeleton requires exact centrifugal repositioning and miniplate osteosynthesis of all bony fragments. Nevertheless, the original height and form of the nose will not be restored with these means in some cases. Therefore, in 23 cases with shattered noses out of 487 midface-trauma patients in the years 1990-1995 the noses were onlay-grafted as the primary procedure in 9 cases via the coronal approach and as the secondary one when the metal plates were removed in 10 cases. A combination of primary and secondary procedures was done in 4 cases. Five times autogenous bone from outer calvarium was used and 22 times allogenic, conserved bone from organ donors (AAA bone). According to extent of the damage, mini-screws and/or mini-plates served to fixate the graft. In addition to the group of 13 patients in the years 1990-1993 with nasal bone grafts via the coronary approach, another group the same size with the same amount of trauma but without rhinoplasty was defined and compared to the first group. An aesthetic analysis was done by grading the results according to simple criteria from 0 to 6 points by the patient and by the examiner. Noses grafted via the coronary approach were evaluated as being significantly (P = 0.004, t-test for independent samples, SPSS) better (2.1 points on average +/- 1.1 SD) than conventionally treated noses (3.5 points on average +/- 0.8 SD).