title: Severe saddle nose: choices for augmentation and application of accordion technique against warping.
abstract: BACKGROUND
  Saddle nose deformity presents a significant challenge to surgeons. The reconstruction of a saddle nose requires structural addition to the nasal dorsum and tip. Costal cartilage grafts have been utilized for fixing severe saddle nose deformity, but costal cartilage is notorious for early and/or late warping. In addition to well-known measures, the efficacy of a preventive surgical technique against warping was investigated in this study.
  
  
  METHODS
  Costal cartilage grafts were used in 18 patients with severe saddle noses. Due to recurrent and late warping of the grafts, an additional measure was taken in 23 patients with a comparable deformity. In these 23 patients, just before insertion the costal cartilage was transected on 75 % of its horizontal width every 2 mm, alternating between both sides along the entire length of the implant, a so-called "accordion technique."
  
  
  RESULTS
  With traditional measures early and/or late warping of the graft was observed in 7 (39 %) of 18 patients postoperatively. Two grafts warped so severely that they required revision surgery. On the other hand, additional use of the accordion technique prevented the costal cartilage from warping in all 23 cases. The warping complication rate was significantly higher in patients whose graft did not undergo the described accordion technique.
  
  
  CONCLUSIONS
  The accordion technique is thought to break the recoil mechanism responsible for warping. Since incorporating this surgical technique, warping has not been seen in any saddle nose deformity patients treated by us in the last 5 years. This simple technique is strongly recommended in these cases.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors                      www.springer.com/00266                                        .
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Bulvarı Vatan Caddesi, 34093, Fatih/İstanbul, Turkey.
authors.forename: Orhan
authors.initials: O
authors.lastname: Ozturan
authors.forename: Fadlullah
authors.initials: F
authors.lastname: Aksoy
authors.forename: Bayram
authors.initials: B
authors.lastname: Veyseller
authors.forename: Tayfun
authors.initials: T
authors.lastname: Apuhan
authors.forename: Yavuz Selim
authors.initials: YS
authors.lastname: Yıldırım
mesh_terms: D000328:Adult; D002356:Cartilage / Q000637:transplantation; D005260:Female; D006801:Humans; D008297:Male; D009667:Nose Deformities, Acquired / Q000209:etiology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000009:adverse effects / Q000379:methods*; D012272:Ribs / Q000637:transplantation; D012720:Severity of Illness Index