Copyright © 2019 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited. A Novel Technique to Fabricate Customized Nasal Splint To the Editor: nostril stenosis is a sequela of post-trauma, burns, and cleft lip nasal deformity repair. The corrected stenosis after surgical release has a tendency to relapse. Similarly, after correction of cleft lip nasal deformity, the relapse of the deformity is very common unless some retainers are used for long-term in the post- operative period. 1,2 Various kinds of intranasal splints such as hollow nasopharyngeal airway tube, soft silicone rubber stents (Porex, Newnan, GA, and Koken Co, Ltd, Tokyo, Japan), hollow acrylic tubing bent into a horseshoe shape, and splints fashioned out of polyvinyl dental bite registration material and methylmethacry- late and expansile stents have been described. 3 These commercially available splinting devices are very expensive. We have designed an indigenous silicone internal nasal splint (Fig. 1). It not only provides support for the ala but also carries a hole for comfortable breathing while the splint is in use. The splint is customized, lightweight, and easy to wear. The cost of 1 silicone splint is around 100 rupees compared to the splints available in the market which may cost 100 times more. FABRICATION OF SPLINT We need only a silicone urinary catheter (size as per nostril size) and a 0.5 mm or 1 mm K wire for fabrication of the splint. The urinary catheter is cut for the required length (width of base of columella þ 40 mm). There are 2 holes in the lumen of catheter, 1 big and small hole. A suitable sized K-wire is inserted into the small hole, keeping its length a little smaller than the length of the tube to avoid any sharp edges protruding out. The catheter with the k wire in situ is bent into U shape, keeping length of horizontal turn equal to width of columella. The gap between the vertical arms of the splint is kept 2 to 3 mm lesser than the width of the columella. The portion of silicone tube (outer layer) on the convex surface is cut. This will open the air passage of the splint. An additional layer of vertically split silicone tube of 5 to 6 mm length may be added on top of the 1 arm with the help of glue when the splint has tobe customized to match size of the nostril. PATIENT SUMMARY A 24-year-old female presented with post-burn sequelae of face with loss of nose and burns to the forehead region. As forehead region was scarred, we decided to reconstruct the nose with pedicledradial forarm flap to form the cover and lining for the vestibule and nasal mucosa. Three months after flap transfer, patient underwent flap thinning and cartilage grafting for tip reshaping. It was followed by nasal splinting with a custom made splint (Fig. 2). Patient used this stent for 6 months duration and reported it to be lightweight, easy to wear, clean, and without obstructing the breathing. The compliance was also good as the patient was able to retain the stent for 18 to 20 hours per day. Parmod Kumar, MCh K.S. Ajai, MS Ramesh Kumar Sharma, MCh Harbans Singh, BSc Plastic Surgery, PGIMER, Chandigarh, India ajaiks1985@gmail.com REFERENCES 1. Wolfe SA, Podda S, Mejia M. Correction of nostril stenosis and alteration of nostril shape with an ortho nostric device. Plast Reconstr Surg 2008;121:1974–1977 2. Ebrahimi A, Shams A. Severe iatrogenic nostril stenosis. Indian J Plast Surg 2015;48:305–308 3. Bajaj A, Shetty V, Pahwa I, et al. The use of a simplified nasal stent in infants with complete unilateral cleft lip and palate. J Oral Maxillofac Surg 2012;70:e415–e418 Importance of Oral and Maxillofacial Surgeons in the Emergency Attendance: Report of an Extensive Facial Cut- Blunt Injury To the Editor: Advanced Trauma Life Support has become a standard global protocol, providing a structured, priority-based treatment system. The guidelines of the American Heart Associ- ation advocate the interruption of bleeding as the initial priority of care of polytrauma patients with cardiopulmonary arrest. 1 Thus, the proper suture technique is vital for wound care, avoiding possible infections and achieving an acceptable aesthetic result. 2 Thus, this study aimed report a case of a 25-year-old male patient, referred to the emergency center due to an auto accident. The patient was unconscious and showed an extensive face cut- blunt injury, which rushed from the upper lip extending until the right nostril, right dorsal nasal region, inner corner of eye, right upper eyelid; lower right eyelid to malar region; frontal region of left side, reaching upper eyelid on left side; and the mental region (Fig. 1A). The patient showed active bleeding, and skin-abrasive wounds all over its face. There were no signs of fracture and it was observed the maintenance of the facial bone pillars and patent airways. First, it was performed an accurate debridement in the whole wound extension, and then sutures were made to contain the FIGURE 1. (Left) Materials required for fabricating the splint. (Middle)—nasal splint formed after bending k wire with horizontal outer convex surface of silicone catheter cut. (Right) Splint with additional silicone tube added to match the nostril size. FIGURE 2. (Left) Nostril appearance of nostrils before using the splint. (Middle) Customized splint in situ. (Right) Nostril appearance after use of the customized splint. CORRESPONDENCE 1614 The Journal of Craniofacial Surgery  Volume 30, Number 5, July 2019