Fixation of silicone implants in augmentation rhinoplasty

Abstract

In rhinoplasty, the use of solid silicone implant is increasing each year. Insertion of an implant is intended to replace the volume of bone and cartilage removed, and fixation of the implant to the bone surface is very important. The operation is not successful if the implant is not properly aligned with the dorsum nasi when the patient feels the nose after the operation. Furthermore, the quality of fixation is important in preventing postoperative complications. Since rhinoplasty is an operation with a blind viewing field, the position of the implant after insertion cannot be clearly seen, and opinion has been divided as to whether it is better to insert the implant beneath the periosteum or above it. In an experiment using rats, fixation was studied by placing implants directly on the bone or on the periosteum, and union with the bone was found to occur in the former case. This indicates the importance of periosteum peeling in rhinoplasty. The next consideration was whether formation of a pocket for inserting the end of the implant beneath the periosteum at the time of rhinoplasty was possible or not. Macroscopically, at the time of nasal tumor operation, it was possible to peel the nasal bone periosteum by the end of the eleverium. Under light microscopy if the periosteum and the peripheral tissues were extended to twice their usual length, the elongated periosteum was continuous. As a result, it was possible to peel beneath the periosteum and form a pocket. If, however the periosteum is broken, and the implant is placed in contact with the bone surface, it seems that good fixation might also be obtained. In any case, appropriate nasal bone separation operation is very important for successful rhinoplasty. © 1988, The Showa University Society. All rights reserved.