Polydioxanone Absorbable Plate for Cartilaginous Grafting in Endonasal Rhinoplasty: A Randomized Clinical Trial

Overview

A caudal septal extension graft sets nasal tip projection, but is hard to hold straight and stable when surgery is done inside the nostrils. The authors tested whether a plate of polydioxanone, a material the body absorbs, makes the graft easier to place and keeps it stable. Patients were randomly assigned to graft with or without the plate.

Sections of note

• Open-label randomised trial, 30 patients in two groups of 15, all operated at one centre between February 2011 and December 2013.
• 27 patients reached the six-month visit and 19 completed the full 12 months.
• Surgeon-rated technical difficulty on a 0 to 100 scale was 46 without the plate and 17 with it, p less than 0.001.
• Surgeon satisfaction with the graft did not differ between groups (p = 0.34).
• A blinded evaluator reviewing standardised photographs at 30, 60, 180 and 365 days found no significant difference between groups (p greater than 0.99).
• Change in tip projection from day 30 to day 365 was minus 0.31 percent with the plate against minus 6.5 percent without, p = 0.04. One infection occurred in each group, with no rejection or extrusion.

What it means for a patient

• The plate did not make the nose look different to an independent assessor, but it did hold the tip position more steadily over the first year.
• It made the operation technically easier, which matters mainly to the surgeon.
• The plate dissolves over time, so nothing permanent is left behind, and no rejection occurred in either group.
• Thirty patients randomised, only 19 completing the year, and a single centre, so the projection finding rests on small numbers.

Why this paper matters

Loss of tip projection during the first postoperative year is a common cause of disappointment, and randomised trials of rhinoplasty hardware are rare. This one isolates a single variable. Whether the difference persists past twelve months, and whether patients notice a 6 percent change, is not answered.

Terms

• Polydioxanone: an absorbable synthetic material, also used for dissolving stitches.
• Caudal septal extension graft: cartilage attached to the front edge of the septum to set tip position.
• Endonasal approach: rhinoplasty performed entirely through incisions inside the nostrils.
• Extrusion: an implant or graft working its way out through the tissue.