title: Salvage of calvarial bone graft using acellular dermal matrix in nasal reconstruction and secondary rhinoplasty for frontonasal dysplasia.
abstract: Frontonasal dysplasia is a severe malformation composed of cranial, ophthalmic, nasal, upper lip, and palatal deformities. Reconstruction in these patients requires complex craniofacial efforts. A 19-year-old woman with frontonasal dysplasia was treated at our institution where she had undergone multiple prior reconstructive surgeries including facial bipartition and cantilevered calvarial bone graft for nasal reconstruction. She later presented with a palpable bone graft prominence, associated contour deformity, and an area of overlying paper-thin skin at the nasal tip. Although there was no ulceration, the threat of graft extrusion required immediate attention. The prominent bone graft tip was debrided, and the overlying soft tissue envelope was augmented using acellular dermal matrix. No surgical complication was encountered. The patient had successful salvage of the bone graft and a pleasing aesthetic outcome at 9 months of follow-up. The use of acellular dermal matrix has proven to be beneficial in the correction of nasal contour deformities given its soft, natural appearance, availability, affordability, and safety. Its use also avoids further donor site morbidity. We suggest acellular dermal matrix as a graft material in revision rhinoplasties for cases of acquired nasal contour deformity and threatened bone graft extrusion. This is the first report known to the authors using acellular dermal matrix during staged nasal reconstruction in a patient experiencing frontonasal dysplasia.
authors.affiliation: Mount Sinai School of Medicine, Kravis Children's Hospital, New York, New York, USA.
authors.forename: E Hanson
authors.initials: EH
authors.lastname: Lenyoun
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Lampert
authors.forename: George D
authors.initials: GD
authors.lastname: Xipoleas
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Taub
mesh_terms: D001672:Biocompatible Materials / Q000627:therapeutic use*; D016025:Bone Transplantation / Q000473:pathology*; D003094:Collagen / Q000627:therapeutic use*; D000013:Congenital Abnormalities / Q000601:surgery*; D019465:Craniofacial Abnormalities; D062109:Dermatologic Surgical Procedures; D005145:Face / Q000002:abnormalities* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009666:Nose / Q000601:surgery*; D009667:Nose Deformities, Acquired / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012225:Rhinoplasty / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: C440568:Alloderm; D001672:Biocompatible Materials; D003094:Collagen