Saddle Nose Reconstruction with Bone Graft in Multiple Facial Fracture Patients

Background: Saddle nose deformities mostly result from trauma. Most reports of saddle nose correction after trauma relate to isolated fractures, but in this article the experience of the authors is presented in relation to bone grafting for the correction of the saddle nose in multiple facial fracture patients. Objectives: The current study aimed to report the results of a protocol for choosing the source of bone graft for dorsal nasal bone grafting in acute trauma patients with multiple facial fractures. Patients and Methods: In a retrospective study, archived files of maxillofacial trauma patients who were treated between 2005 and 2012 at Mashhad Emdad hospital (a level one trauma center) were reviewed. Cases were selected in which a traumatic saddle nose deformity concomitant with other facial fractures had been corrected with dorsal nasal bone grafting. The donor site, type of fixation, access to the dorsum of the nose, associated facial fractures, shape of the graft (cantilever or L-shaped), and plane of dissection in the dorsum of the nose (subperiosteal or subcutaneous) were assessed. Results: There were 11 patients treated using this method. The male-to-female ratio was 7:5. One miniscrew with the lag technique was the preferred method for the fixation of the dorsal nasal bone graft. Splitcalvarial bone graft was the most commonly used type of bone graft. An open rhinoplasty approach and maxillary degloving were two commonly used incisions, and the most commonly associated fractures were maxillary Lefort fractures. The cantilever design was used in eight patients for the correction of the saddle nose deformity, and in four patients the bone graft was inserted into the nose in the subcutaneous plane. Conclusions: Saddle nose reconstruction with bone graft in multiple facial fracture patients is a predictable method if surgical accesses to the region are carefully designed, considering the accompanying fractures.