Nov 18

Ethmoid bone grafts in Rhinoplasty and Revision Rhinoplasty

Recently we’ve seen a number of people who have asked about the use of ethmoid bone in revision rhinoplasty. Each had previously undergone a nose job that had over time either resulted in loss of tip support- resulting in a droopy nasal tip- or had a twisted nose which had been partially corrected but over time had twisted again- resulting in a crooked nasal tip.

There have been a number of papers over the last few years regarding the use of ethmoid bone as stents in an attempt at correcting a caudal (anterior/front) septal deviation. We’ve also heard of their utilization in a similar manner with other grafts. While the initial results look pretty good, we have yet to go to ethmoid bone as a source for a couple reasons.

First, and foremost, even in 3rd and 4th time revision nose jobs, we have always found enough cartilage via the septum and/ or ears. These sources bring cartilage, as opposed to bone, and as such are much more in line with normal anatomy found in the areas of the nose usually requiring correction. As for correction of anterior/ caudal deflection we have also found that in almost every case this can be corrected without a stent, though we have no objection to the use of a stent graft for correction when necessary. Finally, our major concern with the use of ethmoid grafts in other areas of the nose as stand alone grafts is the high likelihood of resorption long term. One of the original innovators in the use of ethmoid bone was the now retired Dr Jack Sheen. In a conversation with him in the year prior to his retirement, he intimated that he had stopped using ethmoid bone grafts due to their high resorption rate.

Having had more experience than anyone else we know of, and taking into consideration all of the other potential sources of grafting material, ethmoid bone is lower on our personal list of graft sources.

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5 comments

5 Comments so far

  1. crying November 23rd, 2009 9:08 am

    Dear Dr Litner and Dr Solieman,

    I’m from Belgium and I’m searching lots of info about the crooked nose. I need a revision but I’m really scared, because my case is very difficult: nose is very crooked, upturned, bridge and tip extremely deviated, beginning of tip bossae, very deviated septum…and my mediteranean, mixed north african etnicity has been taken away from me(very shocking and devestating). I feel so tortured.

    In my search, i’m currently researching about K-wire.
    I was wondering if you use it? In wich cases? Or do you you use an alternative method like an other doc describes very briefly on his site.

    Anyway i wanted you to know that I’m very thankfull for all the important info you docs are presenting on your website. You really are at the top on my list and i’ve heard many happy patients of you! God bless you!
    Sorry for my bad european spelling đŸ˜‰

  2. admin November 23rd, 2009 11:58 am

    Dear crying1,

    Your spelling is actually very good, far better than my French! I’m sorry you’ve had so much difficulty with your nose. I know you are really scared, but you really should have hope that, in the hands of experienced revision rhinoplasty surgeons, you truly can be helped.

    You should be congratulated for doing a lot of research. As for your question about K-wire, this is something that most surgeons would typically use only in major reconstructive cases, such as when the entire nose is being rebuilt after trauma or cancer surgery.

    In rhinoplasty, there are some surgeons who use K-wire to try to stabilize rib grafts and prevent them from warping. We have experience using a patient’s own rib or irradiated rib to rebuild the bridge in severe cases and we have not found K-wire to be necessary. In fact, Dr. Solieman was involved with a paper that was just published in the Archives of Facial Plastic Surgery showing a low complication rate in the largest series of irradiated rib graft cases.

    We would be happy to talk to you in more detail about your concerns and options. Please feel free to send us some photos and we can arrange some time to talk via telephone or skype. Hopefully, we can help you move down the path to feeling better about your nose and change your name from crying1 to smiling1 đŸ˜‰

    Take care,
    Drs. Litner and Solieman

  3. crying November 24th, 2009 3:57 am

    Dear doctors,

    thank you so much for answering personally I really appreciate!

    Your last sentence of me changing my name from crying to smiling really made me emotianal…I mean the thought of having a normal symmetric nose again…until now it still has remained a lifelong dream but you really gave me some hope again.
    I will certainly contact you after my exam period.By the way it’s really nice and cool of you docs offering long distance consultations with skype! I think that’s really awsome.

    You will be hearing soon from me.

    Greetz from Belgium

  4. Manaz December 10th, 2009 12:05 pm

    Cher ami de la Belgique,
    I had revision rhino at Profiles; I am writing this because I hear myself in you.I had a difficult nose, ask Dr. Solieman ;).

    I know it is difficult to TRUST because ‘we’ the patients, know that most doctors in this field want to sell it to you.
    It is a big investment, It is scarry,you want the nightmare to be over once and for all and you certainly don’t want to feel scammed or like a victim again.

    I ate,slept and dreamnt of the day I am living now. The poeple who know me were floored by the results (très impressionnĂ©s) because the nose they see looks so natural and perfect they couldn’t remember what it looked like before.

    You can read all you want about them and see before and after pictures on the site but one very important factor (maybe the most important to me) is that they are HUMBLE and because of that you feel safe and you know that they heard and considered all of what you said and asked for.

    I know that if there’s something that can be done for you, they will do it and they will do it professionally and elegantly.

    Wishing you the best!
    Manaz

  5. crying December 14th, 2009 1:39 pm

    Hi Manaz,

    thank you for sharing your story. Yes indeed, revision rhinoplasty is very scarry for patients who really lost trust…I mean, I really feel mutilated by that Belgian doctor. I really feel hopefull towards Dr Litner and Dr Solieman. They really seem to be very skilled and very kind!
    I mean, without hope, I would not be able to proceed with my life… Anyway, feel always free to mail me your story with your nose issues. I am particularly interested in the severely crooked nose deformity, but any story is welcome..After my exams, probably in februari, I will contact the doctors at profile.When there is hope, there is life…

    crying1@live.com

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