Archives of Orofacial Sciences (2010), 5(2): 53-57 53 CASE REPORT Early intervention following an unusual late complication of cantilever nasal costochondral grafts Shaheel Chummun a *, W.M. Janahi b , N.R. McLean b , P.J. Anderson b , D.J. David b a Department of Plastic Surgery, Derriford Hospital, Plymouth, PL6 8DH, United Kingdom. b Australian Craniofacial Unit, Women’s and Children’s Hospital, Adelaide, SA 5006, Australia. (Revised manuscript accepted 23 August 2010) Keywords cantilever bone graft, nasal reconstruction, saddle nasal deformity. Abstract The concept of the cantilever bone graft, popularised by Millard (1966), and its subsequent modification by Chait et al. (1980), led to the idea of the costochondral cantilever graft for nasal dorsum augmentation. Over 150 costochondral nasal grafts have been performed at the Australian Craniofacial Unit (ACFU) over the last 25 years, and the aim of this study was to review a cohort of fractured costochondral graft in patients treated at the ACFU. The notes of patients with nasal costochondral grafts were reviewed, those with a fractured graft forming the basis of this study. Patients with Binder Syndrome accounted for nearly 30% of the cohort. Other diagnoses included Opitz syndrome, frontonasal dysplasia and other craniofacial abnormalities. 3 patients were identified with late fractured costochondral grafts. The prominent position of the nose makes it easily susceptible to trauma, and very often, low energy impact can produce fractures of the nasal bones. To the best of our knowledge, this is the first reported series of fractures of costochondral nasal grafts and their subsequent management. We would advocate early surgical management of the fractured grafts when conservative treatment has failed. In our present series, all 3 patients still maintained a satisfactory cosmetic and functional result after a mean of 8.5 years following the reparative surgery. Introduction Saddle nasal deformity, characterized by a hypoplastic nasal dorsum with or without a poorly supported nasal tip, is one of the stigmata of craniofacial anomalies and a possible consequence of trauma. Other potential causes include syphilis, Wegner’s granulomatosis and post rhinoplasty. The main aim of surgery is to improve the contour of the nose and also enhance its function. This can be achieved by the use of various autogenous or alloplastic implants, the latter being shown to be less efficacious as a result of a higher rate of infection, extrusion and rejection (Tardy, 1990). Bone and cartilage are the most widely used autogenous materials for nasal dorsal augmentation, bone grafts being harvested from the calvarium, iliac crest or rib, while cartilage grafts can be obtained from the nasal septum, ear concha or rib (McDowell, 1970a; McDowell, 1970b; Jackson et al., 1983). The concept of the cantilever principle for nasal dorsal augmentation was introduced in the 1950s (Farina and Villano, 1971), and later popularised by Millard (Millard, 1966) in 1966. A cantilever graft is used when nasal tip projection is required, with the distal end of the graft being inserted between the lower lateral cartilages in an attempt to preserve normal tip appearance. However, excessive tip rigidity and increased bone resorption have been reported by Farina and Villano (Farina and Villano, 1971) with the use of bone grafts as cantilever grafts. To address this issue, Chait (Chait et al., 1980) described the maintenance of a segment of cartilage with the resected ‘bony’ costal graft, which * Corresponding author: Mr. Shaheel Chummun, Tel: + 44 7818001890, e-mail: shaheelchummun@hotmail.com