The Use of Bone Dust to Correct the Open Roof Deformity in Rhinoplasty

Overview

Removing a hump leaves a flat open gap across the top of the nose, normally closed by cutting the nasal bones and moving them inward. Those cuts are difficult in a patient whose bony vault is already narrow. This paper describes filling the gap with bone dust from the hump itself instead.

Sections of note

• 240 patients enrolled and operated on: 187 female and 53 male.
• Four steps: complete submembranous dissection, preparation of spreader flaps, harvesting bone dust from the bony hump, and placing the bone dust.
• The bridge was assessed by ultrasonography; standard postoperative photographs were inspected by two independent plastic surgeons.
• A senior surgeon performed a palpation test of the bridge to detect irregularities.
• A rhinoplasty outcomes evaluation questionnaire was given at the 1-year visit; functional improvement was assessed by patient self-evaluation of nasal patency.
• 182 of 240 patients completed the 1-year follow-up and questionnaire; 37 patients were assessed by ultrasound at 1 year.
• No resorption or displacement was detected, high patient satisfaction was reported, and no complications were encountered.

What it means for a patient

• The gap can be filled with material already removed, avoiding bone cuts that carry bruising and swelling.
• Ultrasound at 1 year found the bone dust still in place in the 37 patients scanned.
• Limits: single surgeon, no comparison group against conventional lateral osteotomy, 58 of 240 patients lost to 1-year follow-up, and only 37 imaged.
• Satisfaction figures are reported as high without a numeric value in the abstract.

Why this paper matters

Lateral osteotomy is the standard fix for an open roof but is a major contributor to bruising and swelling and is unsuitable for narrow noses. Using bone dust avoids it in selected patients. Without a comparison group the technique's relative performance is unmeasured.

Terms

• Open roof deformity: The flat gap left across the top of the nose after a hump is removed.
• Lateral osteotomy: A bone cut along the side of the nose allowing the bones to be moved inward.
• Bone dust: Fine bone particles collected while rasping or reducing bone.
• Spreader flap: The upper lateral cartilage folded inward to support the middle vault.
• Resorption: Gradual absorption of grafted material by the body.