Graft selection remains the greatest challenge for surgeons performing rhinoplasty. The preferred choice thus far for nasal reconstruction would be autograft compared to allograft due to its lower rate of infection and extrusion as it does not induce an immune response. We have evaluated 26 patients who underwent open structured rhinoplasty at our center and compared our experience regarding the operative technique, graft availability, indications, and limitations. The racial distribution was 18 Indians, 5 Chinese, and 3 Malays with a mean age, hospitalization, and followup of 30.5 years, 16.9 months, and 4.4 days, respectively. Majority of the patients (57.6%) presented with twisted nose and 30.7% of the patients presented with history of nasal trauma. All the patients had deviated septum of varying severity. The most common graft used was quadrangular cartilage graft and the common complications noted were ala deformity and tip anaesthesia in 7.6% patients respectively. 1. Introduction In multiethnic Malaysian population, the nasal profile and skin thickness in the Oriental Chinese and Malay noses vary from the Caucasian Middle Eastern and Indian noses. Augmentation rhinoplasty is more common in Oriental Chinese or Malay noses whereas reduction rhinoplasty is more common in Middle Eastern and Indian noses. Rhinoplasty is an operation planned to reshape the anatomic features of the nose into a new more pleasing relationship with the surrounding facial features. Rhinoplasty consists of septoplasty, tip remodeling, hump removal, narrowing of nose with osteotomies, and final correction of subtle deformities. The results achieved in rhinoplasty are directly related to the surgeon’s ability to elucidate how subtle change in the bony and cartilaginous support of the nose will change its appearance [1]. Numerous grafting techniques have been developed to sculpt the nasal framework in rhinoplasty over time. These basic techniques have evolved from the principal that maintenance of major supporting structures of the nose is fundamental for aesthetic and functional purposes. However, the type of graft, its shape, position, and usage may vary depending on the situation and the objectives of the surgeon. Despite the advances and the multiple techniques that have been described in the literature, it can be a steep learning curve and a daunting task for the aspiring rhinoplasty surgeon. The surgeon’s attention to functional, reconstructive, and aesthetic principles is paramount in ensuring optimum septorhinoplasty results, much to the satisfaction of both the
References
[1]
J. R. Anderson, “A reasoned approach to nasal base surgery,” Archives of Otolaryngology, vol. 110, no. 6, pp. 349–358, 1984.
[2]
W. P. Adams Jr., R. J. Rohrich, L. H. Hollier, J. Minoli, L. K. Thornton, and I. Gyimesi, “Anatomic basis and clinical implications for nasal tip support in open versus closed rhinoplasty,” Plastic and Reconstructive Surgery, vol. 103, no. 1, pp. 255–264, 1999.
[3]
J. H. Sheen, “Closed versus open rhinoplasty—and the debate goes on,” Plastic and Reconstructive Surgery, vol. 99, no. 3, pp. 859–862, 1997.
[4]
S. Brown, “Otolaryngology,” in Rhinology, vol. 4, p. 260, 5th edition, 1987.
[5]
P. A. Adamson, J. A. Litner, and R. Dahiya, “The M-Arch Model: a new concept of nasal tip dynamics,” Archives of Facial Plastic Surgery, vol. 8, no. 1, pp. 16–25, 2006.
[6]
J. F. Hoffmann, “Management of the twisted nose,” Operative Techniques in Otolaryngology-Head and Neck Surgery, vol. 10, no. 3, pp. 232–237, 1999.
[7]
B. S. Gendeh and V. E. S. Tan, “Open septorhinoplasty: operative technique and grafts,” Medical Journal of Malaysia, vol. 62, no. 1, pp. 13–18, 2007.
[8]
D. Reiter, “Current concepts in functional rhinoplasty,” Current Opinion in Otolaryngology and Head and Neck Surgery, vol. 9, no. 4, pp. 256–264, 2001.
[9]
B. S. Gendeh, M. S. Sakina, B. M. Selladurai, T. Jegan, and K. Misiran, “The transcolumellar transsphenoidal approach to pituitary tumours: advantanges and limitations,” Medical Journal of Malaysia, vol. 61, no. 3, pp. 349–354, 2006.
[10]
M. E. Tardy Jr., J. Denneny III, and M. H. Fritsch, “The versatile cartilage autograft in reconstruction of the nose and face,” Laryngoscope, vol. 95, no. 5, pp. 523–533, 1985.
[11]
J. H. Sheen, “Spreader graft: a method of reconstructing the roof of the middle nasal vault following rhinoplasty,” Plastic and Reconstructive Surgery, vol. 73, no. 2, pp. 230–239, 1984.
[12]
S. Acarturk, E. Arslan, F. Demirkan, and S. Unal, “An algorithm for deciding alternative grafting materials used in secondary rhinoplasty,” Journal of Plastic, Reconstructive and Aesthetic Surgery, vol. 59, no. 4, pp. 409–416, 2006.
[13]
J. P. Gunter, C. P. Clark, and R. M. Friedman, “Internal stabilization of autogenous rib cartilage grafts in rhinoplasty: a barrier to cartilage warping,” Plastic and Reconstructive Surgery, vol. 100, no. 1, pp. 161–169, 1997.
[14]
M. G. Spencer, “Chondroplastic graft augmentation rhinoplasty,” Journal of Laryngology and Otology, vol. 104, no. 7, pp. 539–543, 1990.
[15]
H. D. Gilles, Plastic Surgery of the Face, Oxford University Press, London, UK, 1920.
[16]
T. Gibson and W. B. Davis, “The distortion of autogenous cartilage grafts: its cause and prevention,” British Journal of Plastic Surgery C, vol. 10, pp. 257–274, 1957.
[17]
M. A. Lopez, A. R. Shah, J. G. Westine, K. O'Grady, and D. M. Toriumi, “Analysis of the physical properties of costal cartilage in a porcine model,” Archives of Facial Plastic Surgery, vol. 9, no. 1, pp. 35–39, 2007.
[18]
D. A. Sherris, “Graft choices in aesthetic and reconstructive rhinoplasty,” in Proceedings of the 16th World Congress of Otorhinolaryngology Head Neck Surgery, G. McCafferty, W. Coman, and C. R. Monduzzi, Eds., pp. 157–160, Bologna, Italy, 1997.
[19]
J. P. Rubin and M. J. Yaremchuk, “Complications and toxicities of implantable biomaterials used in facial reconstructive and aesthetic surgery: a comprehensive review of the literature,” Plastic and Reconstructive Surgery, vol. 100, no. 5, pp. 1336–1353, 1997.
[20]
M. W. Pak, “Late complications of nasal augmentation using silicone implants,” Journal of Laryngology and Otology, vol. 112, no. 11, pp. 1074–1077, 1998.
[21]
S. C. L. Leong and P. S. White, “A comparison of aesthetic proportions between the Oriental and Caucasian nose,” Clinical Otolaryngology and Allied Sciences, vol. 29, no. 6, pp. 672–676, 2004.
[22]
B. S. Gendeh and S. Mallina, “Graft selection in rinoplasty: indications and limitations,” Medical Journal of Malaysia, vol. 63, no. 1, pp. 35–38, 2008.
[23]
R. T. Farrior, E. H. Farrior, and R. Cook, “Special rhinoplasty techniques,” in Cummings: Otolarynglogy Head Neck Surgery, C. W. Cummings, P. W. Flint, L. A. Harker et al., Eds., pp. 1078–1114, Elsevier Mosby, Philadelphia, Pa, USA, 4th edition, 2005.
[24]
H. M. T. Foda, “External rhinoplasty: a critical analysis of 500 cases,” Journal of Laryngology and Otology, vol. 117, no. 6, pp. 473–477, 2003.
