Summary
There has still been no reduction in the detection rate worldwide for leprosy, despite
supervised multi-drug therapy. In time, leprosy can result in a severe saddle-nose
deformity leading to functional problems, disfiguration and stigmatization. In severe
cases, only the nasal skin tissue and the lower lateral cartilages are preserved.
In such cases, the ideal would be to restore the cartilaginous skeleton but, by contrast
with other causes of saddle-nose deformities, this is complicated by the quantity
and the poor quality of the remaining nasal mucosa. Leprosy-related saddle-nose deformities
are therefore challenging and difficult to reconstruct with the techniques that have
been proposed in the past. In this study, 24 patients underwent rhinoplastic surgery
involving the use of autogenous costal and/or auricular cartilage or composite grafts.
The nasal septum, the upper laterals and the anterior nasal spine were reconstructed
with a dorsal onlay attached to a columellar strut with an extension on the proximal
side. Before surgery, the saddle-nose deformities were classified according to severity
with a new system based on clinical symptoms and signs. Postoperative evaluation was
performed at least two years after surgery (N=17). Functional and aesthetic improvement, resorption rate, warping, infection and
extrusion were analysed. Functional and aesthetic improvements were achieved in 15/17
patients. None of the patients developed an infection and extrusion or warping of
the implants was not observed. The resorption rate depended on the localization and
the type of cartilage implant. In general, auricular conchal cartilage implant grafts
resulted in less resorption than costal cartilage. Least resorption (4/17 patients)
was observed in the dorsal onlay grafts of both conchal (1/6) and costal cartilage
grafts (3/11). Resorption of columellar strut implants and shield grafts was observed
in 7/17 patients. No resorption was seen of composite grafts (0/4) and alar battens
(0/7). Autogenous cartilage implants can be used to reconstruct saddle-nose deformities
in leprosy with a minimum risk of complications. The preoperative grade of severity
was used as a basis for the development of guidelines for optimal long-term functional
and aesthetic outcome.
Keywords
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Article info
Publication history
Published online: September 18, 2006
Accepted:
June 9,
2006
Received:
January 5,
2006
Footnotes
☆Figure consent: All photographs in the article ‘Reconstructive surgery of the leprosy nose: A new approach’ are taken from patients who had surgery in the Lauro de Souza Lima Institute in Bauru, Brazil. Before surgery all patients gave permission to use the pre-, per- and postoperative photographs for clinical demonstrations and for publication.
Identification
Copyright
© 2006 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
