A new classification system of nasal contractures

Abstract

Background: The nasal contracture is one of the most severe complications that follow rhinoplasty. The proposed reasons for this complication are a capsular contraction from the silicone implant, pressure necrosis of the lower lateral cartilage due to the long nasal implant, and inflammation after alloplastic implantation. The severity and extent of nasal contracture vary depending on the cause and duration. Treatment of nasal contractures is very challenging and different from normal rhinoplasty procedures. To the best of our knowledge, an established classification has yet to be introduced for effective treatment. Objective: To introduce a system for the classification of nasal contractures, for effective treatment decision-making. Methods: Data from 245 nasal contractures were reviewed retrospectively. Pre-operatively, a complete rhinological examination including photographs was performed and a prior surgical history was taken. Two hundred forty-five patients had surgical treatments with various procedures. The authors classified the 245 cases according to severity and analyzed the patients' data, including previous implants, infection history, and surgical procedures. Results: Nasal contractures were classified into 6 categories. Type II (symmetric type, 42.4%) and Type III (asymmetric type, 33.5%) were the most common. A previous silicone implant was found in 77% of all cases of nasal contractures. A previous infection occurred in 56% of the cases. Extended spreader graft and strut graft were used for surgical treatment in 87% of the cases. Conclusion: The authors have presented a new classification system of nasal contractures. Histories of a previous infection and previous silicone implant could be relevant parameters, however, it is not clear if they are direct causative factors. There was no significant correlation between the surgical management and type of nasal contracture. Level of evidence: 3

A systematic review of complications associated with nasal augmentation implants: expanded polytetrafluoroethylene (Gore-Tex) versus silicone

“…In their study, 29.3% of patients developed noticeable contracture, and 13.8% required capsulectomy plus or minus significant revisions. Chang and Jung [28] also reported a high rate of capsular contracture with silicone nasal implants in a new study published by the Journal of Cosmetic Medicine. In this study, 77% of all capsular contracture cases were related to the usage of silicone implants.…”