Arch Aesthetic Plast Surg.  2016 Oct;22(3):149-152. 10.14730/aaps.2016.22.3.149.

Bone Framework Graft through an Intraoral Approach in a Patient with Columellar Scar Contracture

• Kim MG
• Park IH
• Pak CS
• Kim BK
• Jeong JH

• KMID: 2356765
• DOI: http://doi.org/10.14730/aaps.2016.22.3.149

Abstract

We present our experience with calvarial bone framework insertion through an intraoral approach for a patient who was at risk for columellar necrosis due to a previous open rhinoplasty. A 58-year-old woman exhibited severe columellar contracture, so that the columellar tissue was too fragile to be touched. We could not incise the columella and insert a new nasal implant through the bilateral rim incision. Moreover, the patient had septal cartilage perforation and collapse. The patient needed columellar support as well as nasal dorsum reconstruction. The authors decided to graft an autogenous L-strut bone framework through an intraoral approach. Two pieces of 5-cm × 1-cm sized split calvarial bone were harvested and trimmed to fit the width and length of the nasal dorsum and columella. The right-angle-shaped bone framework was made with an absorbable plate and screws. Through a gingivobuccal incision, the bone framework graft was inserted and the graft was fixed with absorbable screws. The patient did not experience complications such as skin necrosis or inflammation. A bone framework grafted through an intraoral approach can be a good choice for patients who have experienced scar contracture in the columella, septal cartilage perforation, and collapse.

Keyword

Contracture; Oral surgical procedures; Rhinoplasty

MeSH Terms

Cartilage
Cicatrix*
Contracture*
Female
Humans
Inflammation
Middle Aged
Necrosis
Oral Surgical Procedures
Rhinoplasty
Skin
Transplants*