Management of Saddle Nose Deformity Using Dermal Fat and Costal Cartilage "Sandwich" Graft: A Problem-Oriented Approach and Anthropometric Evaluation.
OBJECTIVE
In the surgical treatment of saddle nose deformity (SND), costal cartilage is often used. However, it can result in some potential complications such as resorption, bending, displacement, and its appearance under the skin (silhouette deformity). We prepared a composite "sandwich" graft by camouflaging the costal cartilage underneath the dermal fat graft as a novel method and applied it on SNDs using the closed rhinoplasty technique to prevent or minimize these risks.


METHODS
The method was used for 21 patients (12 males and 9 females). Six anthropometric measurements, including the nasal dorsum projection, nasal supratip projection, nasal tip projection, nose length, labiocolumellar angle, and nasofrontal angle, were taken using the ImageJ program (National Institutes of Health, Bethesda, MD) on preoperative and postoperative lateral photographs. The data were compared statistically.


RESULTS
The mean follow-up time was 29.95 months. No donor site complications developed. The sandwich grafts transferred to the nose were well tolerated in all patients. A partial graft failure and a mild bending, which were treated conservatively without supplemental surgery, developed in 1 patient each. No resorption, migration, bending, or appearance under the skin of the sandwich grafts were seen in the remaining patients. A statistically significant difference was found in all anthropometric measurements from the preoperative and postoperative groups except for 2.


CONCLUSIONS
The severity of the deformity should be exactly determined before surgery, and cartilage grafts should be used accordingly for successful repair of SND. The sandwich technique, as a practical, effective, and long-lasting treatment method, could minimize the potential complications and risks of revision.
Professor, Department of Plastic Reconstructive and Aesthetic Surgery, Ataturk University Faculty of Medicine, Erzurum, Turkey. Electronic address: mdtan@atauni.edu.tr.
Onder
O
Tan
Assistant Professor, Department of Plastic Reconstructive and Aesthetic Surgery, Ataturk University Faculty of Medicine, Erzurum, Turkey.
Said
S
Algan
Specialist, Department of Plastic Reconstructive and Aesthetic Surgery, Ataturk University Faculty of Medicine, Erzurum, Turkey.
Hakan
H
Cinal
Specialist, Department of Plastic Reconstructive and Aesthetic Surgery, Ataturk University Faculty of Medicine, Erzurum, Turkey.
Ensar Zafer
EZ
Barin
Resident, Department of Plastic Reconstructive and Aesthetic Surgery, Ataturk University Faculty of Medicine, Erzurum, Turkey.
Murat
M
Kara
Resident, Department of Plastic Reconstructive and Aesthetic Surgery, Ataturk University Faculty of Medicine, Erzurum, Turkey.
Akin
A
Inaloz
D000273:Adipose Tissue / Q000637:transplantation*; D000293:Adolescent; D000328:Adult; D000886:Anthropometry; D066186:Costal Cartilage / Q000637:transplantation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009667:Nose Deformities, Acquired / Q000601:surgery*; D012225:Rhinoplasty / Q000379:methods*; D016896:Treatment Outcome