Letter to the Editor: Comment on Park SH, et al. Posttraumatic Augmentation Rhinoplasty Using an Osseocartilaginous Cantilever Graft (Ann Plast Surg. 2020;84:135–138)

Abstract

To the Editor:W e have read the article "Posttraumatic Augmentation Rhinoplasty Using an Osseocartilaginous Cantilever Graft" by Park et al, 1 and in our point of view and depending on our clinical experiences, there are some points that should be illuminated.According to the experience of the authors, osseocartilaginous rib grafts have been applied to 43 acute nasal fracture patients who have been seeking both reconstruction and aesthetic surgery since 2007. The osteocartilaginous graft was removed from the 7th rib, the spongy side of the graft was rasped, the graft was placed in contact with the nasal bone and fixed using K wires. A suture was applied for type plasty, and then, columellar strut grafting was performed to support weak or injured lower lateral cartilage. When columnar strut graft was not used, osteocartilaginous graft was sutured to the septal angle or middle crus to prevent deviation and lateral subluxation. Patients were followed up for 1 to 2 years after surgery. The only outcome scale used by the authors was the subjective patient satisfaction scores of 1 to 2 years postoperatively.First of all, it is remarkable that you have developed a method other than conventional treatments and enriched your article with preoperative and postoperative photos, so we congratulate you.In the acute setting, aside from closed nasal reduction and laceration repair, most practitioners tend to avoid performing definitive open septorhinoplasty, which requires extensive dissection and cartilage grafting. The trend is to perform conservative procedures acutely and wait for 3 to 6 months before considering a definitive open septorhinoplasty once all of the soft tissue trauma and cartilage contracture forces have stabilized to more accurately reflect long-term appearance and nasal airflow. 2 Although standard treatment is reduction in acute fractures, it is difficult to determine such a graft indication. In fact, this method should have been a secondary plan. How were the indications determined by the authors? In which nasal fractures was osteocartilaginous graft used? We would be glad if you explain these.In a trauma that collapses the nasal bone, the formation of problems with the respiratory tract is obvious. However, in your article, the procedures for solving the problems in the respiratory tract are not mentioned.This study was evaluated according to the satisfaction of the patients. In our opinion, the results of this study would be more valuable if they were made with objective imaging methods, such as computed tomography, instead of subjective scoring.