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.

INTRODUCTION: 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.

CONCLUSION: 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.

LEVEL OF EVIDENCE: Therapeutic Study Level IV, case series with pre/post test.