title: Interlocking calvarial bone grafts: a solution for the short, depressed nose.
abstract: OBJECTIVE
  In patients severely affected with collapse of the nose, deprojection and upward rotation of the nasal tip are commonly seen. Traditional maneuvers to derotate and project the tip may be insufficient, because of the natural tendency of the nasal skin/soft tissue envelope to pull the tip in a cephalic and posterior direction. If the forces of scar contracture can be resisted, the tip and dorsum should remain adequately positioned.
  
  
  METHODS
  Retrospective chart review of 20 cases.
  
  
  METHODS
  Using an open rhinoplasty approach, two strips of calvarial bone are fitted together in a tongue-in-groove fashion, and esthetics are analyzed. Rotation and projection are altered as indicated. A screw inserted at the indicated level along the caudal bone graft acts to prevent retrodisplacement of either the dorsal or caudal strut as scarring occurs.
  
  
  RESULTS
  The procedure has been used in 20 patients. Two patients had displacement of the dorsal bone graft. Two patients have been lost to follow-up. Follow-up in the remainder has ranged from 6 weeks to 4 and a half years. All have maintained adequate tip and dorsal projection without excess upward tip rotation. Bone grafts have undergone minimal resorption.
  
  
  CONCLUSIONS
  The interlocking calvarial bone graft technique stabilizes the nasal tip and dorsum in such a way that resists the forces of contracture and provides improved esthetics and function.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical School-Dallas, 75235, USA.
authors.forename: J
authors.initials: J
authors.lastname: Leach
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D009295:Nasal Bone / Q000293:injuries / Q000601:surgery*; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000379:methods; D012886:Skull / Q000637:transplantation*