Interlocking calvarial bone grafts: A solution for the short, depressed nose

Objectives/Hypothesis: In patients severely affected with collapse of the n ose, deprojection and upward rotation of the nasal tip are commonly seen. T raditional maneuvers to derotate and project the tip may be insufficient, b ecause of the natural tendency of the nasal skin/soft tissue envelope to pu ll the tip in a cephalic and posterior direction, If the forces of scar con tracture can be resisted, the tip and dorsum should remain adequately posit ioned. Study Design: Retrospective chart review of 20 cases. Methods: Using an open rhinoplasty approach, two strips of calvarial bone are fitted toge ther in a tongue-in-groove fashion, and esthetics are analyzed. Rotation an d projection are altered as indicated, A screw inserted at the indicated le vel along the caudal bone graft acts to prevent retrodisplacement of either the dorsal or caudal strut as scarring occurs. Results: The procedure has been used in 20 patients. Two patients had displacement of the dorsal bone graft, Two patients have been lost to follow-up. Follow-up in the remainder has ranged from 6 weeks to 4 and a half years. All have maintained adequat e tip and dorsal projection without excess upward tip rotation. Bone grafts have undergone minimal resorption, Conclusion: The interlocking calvarial bone graft technique stabilizes the nasal tip and dorsum in such a way that resists the forces of contracture and provides improved esthetics and func tion.