title: Avoiding pitfalls in open augmentation rhinoplasty with autologous L-shaped costal cartilage strut grafts for saddle nose collapse due to autoimmune disease: the Cambridge experience.
abstract: BACKGROUND
  Saddle nose deformity due to autoimmune diseases such as Wegener's Granulomatosis and Relapsing Polychondritis is aesthetically, functionally and psychologically distressing for patients. However, "reliable" options for surgical correction remain limited in the literature. We present our experience of augmentation rhinoplasty in this patient population focussing on the techniques and pitfalls of L-shaped costal cartilage grafting.
  
  
  METHODS
  Five patients undergoing rhinoplasty for saddle nose deformity due to an autoimmune condition were identified over an 11-year period at a major tertiary centre. All patients were in remission from their condition at surgery and underwent L-shaped costal cartilage grafting at augmentation rhinoplasty. Case notes were reviewed retrospectively.
  
  
  RESULTS
  All patients achieved a marked improvement in nasal position, shape and contour and were very pleased with their overall appearance. The average length of follow up was 2.8 years. There were no infections, graft exposure or warping. No resorption of cartilage was observed and there have been no recurrent deformities.
  
  
  CONCLUSIONS
  This case series describes a possible approach to corrective rhinoplasty in patients with saddle nose deformity caused by autoimmune disease, highlighting the key technical steps and potential pitfalls of intraoperative and perioperative care in this population. The approach is straightforward, reproducible, and achieved pleasing aesthetic outcomes and high patient satisfaction. Given careful planning and meticulous execution, L-strut cartilage grafts for augmentation rhinoplasty to correct saddle nose deformity in these patients is of great benefit.
  
  
  METHODS
  Therapeutic Study Level IV, case series with pre/post test.
authors.affiliation: Clinical School of Medicine Elective Student, Cambridge University Medical School, Cambridge, England, UK; Clinical School of Medicine, Monash University, Clayton, Victoria, Australia.
authors.forename: S Y
authors.initials: SY
authors.lastname: Qian
authors.affiliation: Department of Plastic and Reconstructive Surgery, Addenbrooke's University Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England, UK; Anglia Ruskin University Postgraduate Medical Institute, Chelmsford & Cambridge, England, UK. Electronic address: cmalata@hotmail.com.
authors.forename: C M
authors.initials: CM
authors.lastname: Malata
mesh_terms: D000328:Adult; D002356:Cartilage / Q000637:transplantation*; D004954:Esthetics; D005260:Female; D014890:Granulomatosis with Polyangiitis / Q000150:complications; D006801:Humans; D008297:Male; D009667:Nose Deformities, Acquired / Q000209:etiology / Q000601:surgery*; D017060:Patient Satisfaction; D011081:Polychondritis, Relapsing / Q000150:complications; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000379:methods*; D012272:Ribs; D014182:Transplantation, Autologous
keywords: Augmentation rhinoplasty; Relapsing polychondritis; Revision rhinoplasty; Rib cartilage grafts; Saddle nose deformity; Wegener's granulomatosis