E-M shaped septal encircling with Medpor reconstruction on crooked noses: personal technique and postoperative results.

Correction of the crooked or deviated nose, a complex cosmetic and functional problem, is a challenge for the rhinoplasty surgeon. Although corrections using a wide range of surgical techniques to straighten the nose and maximize nasal function have been proposed, recurrence is very common because of cartilage memory and scar contracture. Therefore, to prevent recurrence and to maintain the correction of the septum, a stable, strong, and permanent support is needed with the ability to maintain its given shape after placement on one or both sides of the septum. For this purpose, the author planned to use a personally-shaped graft (EMSEN) with high-density porous polyethylene (Medpor, Porex Surgical Inc., Newnan, GA). In this study, the concept and technique of Medpor, composed of a nonresorbable alloplastic material for correction of the crooked nose, and the authors' experience using it, are presented. Currently, Medpor is readily available on the market as a thin plain sheet (0.85 x 38 x 50 mm) that can be cut to an appropriate size for our (EMSEN) grafts. Ingrowths of fibrous tissue inside and around Medpor stabilize the upper lateral cartilages and septum in their newly corrected position and maintain the corrected/straightened position. This material was used in 18 patients with crooked noses (7 with C-type and 11 with S-type noses). During a mean follow-up period of 20 months (range, 10-50 months), there were no complications, recurrences, or extrusions. Functional evaluation was performed using a visual analog scale before surgery and 6 months after surgery. Patients were asked to score their nasal breathing on a scale ranging from 0 to 100. The mean preoperative value was 17.78% +/- 1.23% (range, 15-25%), and the postoperative value was 86.67% +/- 1.21% (range, 80-95%). In conclusion, the use of EMSEN with Medpor grafts is a safe, effective, reliable, and permanent method for correction of the crooked nose. In the long term, the authors believe that EMSEN grafts provide functional recovery and increased strength against further trauma or forces of scar contracture, and have the ability to prevent recurrence attributable to cartilage memory.