A novel umbrella graft approach in nasal reconstruction of patients with frontonasal dysplasia.

Abstract

Frontonasal dysplasia (FND) is a rare craniofacial anomaly characterized by hypertelorism and nasal deformities. Traditional intracranial approaches for correction, such as box osteotomy or facial bipartition, are effective but associated with high morbidity. This study presents an extracranial umbrella graft technique for nasal reconstruction in patients with FND. Between 2014 and 2024, 55 patients with FND were retrospectively evaluated, and 14 met the criteria for extracranial nasal reconstruction. Inclusion criteria were interorbital distance (IOD) <40 mm and the presence of inwardly projecting concave nasal cartilage. Through a midline incision, inverted U-shaped osteotomies were performed to medialize nasal bones. Concave cartilage was harvested, inverted, and used as an umbrella graft to restore nasal projection. Septal cartilage grafts supported the lower nasal framework. Outcomes were assessed by complications and Whitaker classification. This study included 9 females and 5 males (mean age 8.3 years). Mean follow-up was 2.3 years. No major complications, such as cerebrospinal fluid leakage, visual impairment, or infection, were observed. One patient developed pressure sores from splints, and two underwent minor scar revisions. Mean anterior IOD decreased from 34 to 26.9 mm. Three patients reported insufficient projection, whereas all others achieved significant improvement. According to Whitaker classification, 10 patients were category I and 4 were category II. This technique offers a safe, less invasive alternative for nasal reconstruction in selected patients with FND, providing satisfactory esthetic results with minimal morbidity. Although long-term outcomes remain to be clarified, this approach may serve as a valuable option.