The use of bone dust to correct the open roof deformity in rhinoplasty

Background: Hump removal frequently results in an open roof during rhinoplasty, which is conventionally closed with lateral osteotomies. However, if the patient has a narrow bony vault, then lateral osteotomies are problematic. Here, we present a new and practical approach to fix the open roof deformity. Methods: A total of 240 patients (female, 187; male, 53) were enrolled and operated with the presented technique. This approach has four steps as follows: complete submembranous dissection, the preparation of spreader flaps, harvesting the bone dust from the bony hump, and the placement of the bone dust. The patient's nasal dorsum was evaluated by ultrasonography (US). During the follow-up period, all patients were postoperatively photographed from standart views using a digital camera. Photos were inspected by two independent plastic surgeons. A palpation test for the nasal dorsum was conducted by a senior surgeon to identify any irregularities. A rhinoplasty outcomes evaluation (ROE) questionnaire was administered to all patients at a 1-year follow-up visit. Functional improvement was assessed with self-evaluation nasal patency. The chi-square test was used for statistical analysis. Results: Of the 240 patients, 182 completed the 1-year follow-up period and ROE questionnaire. Thirty-seven patients were evaluated by US at postoperative year 1. During the follow-up period, no resorption or displacement was detected. High patient satisfaction was achieved, and no complications were encountered. Conclusions: The presented four-step surgical concept was useful for rhinoplasty surgeons to successfully manage open roof deformity in selected patients. Foot Note: A part of this study was presented in Fifth Bergamo Open Rhinoplasty Course (March 15-19, 2016 in Bergamo, Italy) and selected for Best Presentation Award. Conflict of Interest: 'TAS 1' 'TAS 2' 'TAS 3' were designed by the author (S.T) and patented in the Turkish Patent Institute (No: 2016/05472). These instruments are not commericial avaible yet, however they can be produced by Elektron Medical Company (a Turkish instrument company) with a special order via their website (https://ift.tt/2JBuirL). The author does not receive any payment from the company and has no financial gain. Acknowledgement: The author thanks to Dr.Isil Yurdaisik for her valuable contributions in ultrasonographic evaluation. The use of bone dust to correct the open roof deformity in rhinoplasty Address for correspondence: Süleyman Taş, MD, Hakkı Yeten Cad, No: 11, Terrace Fulya, Center: 1, Apt: 97 Şişli, Istanbul 34349, Turkey. Tel: +90-532-0563693; Fax: +90 212 9793000,. E-mail: drsuleymantas@live.com ©2018American Society of Plastic Surgeons

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