{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T21:00:50Z","timestamp":1793912450487,"version":"4.8.0"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2019,7,1]],"date-time":"2019-07-01T00:00:00Z","timestamp":1561939200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,3,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>In the setting of major nasal framework reconstruction, it is critical to create a stable, warp-resistant L-strut to resist the contractile forces of healing to achieve a durable outcome.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>The authors sought to demonstrate the effectiveness of the osseocartilaginous rib graft for nasal framework reconstruction.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Retrospective analysis was performed of all patients who underwent osseocartilaginous rib graft for L-strut reconstruction from 2007 to 2017 at a tertiary care hospital. Only patients with severe framework-only defects (Type IV, Daniel Classification) or total\/subtotal nasal defects (Type V, Daniel Classification) were included. Primary outcome measures were: (1) maintenance of projection; (2) graft warping; and (3) graft resorption.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Twenty-six patients aged an average of 54.6 years underwent nasal framework reconstruction with an osseocartilaginous rib graft L-strut. Eighteen patients had framework-only deformities (Daniel Type IV) and 8 had total or subtotal nasal deformities (Daniel Type V). Twelve patients underwent reconstruction for autoimmune mediated deformity, 10 for malignancy, 3 for traumatic injury, and 1 for an iatrogenic deformity. Average follow-up was 21 months. There was no observed warping of the L-strut construct, and all but 2 patients demonstrated total maintenance of projection. Resorption of the caudal cartilage graft was identified as the etiology of partial loss of projection in 2 patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The osseocartilaginous rib graft L-strut provides a stable, warp-resistant construct for patients lacking major dorsal and caudal support, which may be applied to reconstruction of defects due to malignancy, autoimmune, traumatic, or iatrogenic etiologies.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Level of Evidence: 4<\/jats:title>\n                  <jats:p\/>\n               <\/jats:sec>","DOI":"10.1093\/asj\/sjz189","type":"journal-article","created":{"date-parts":[[2019,8,17]],"date-time":"2019-08-17T13:15:05Z","timestamp":1566047705000},"page":"NP133-NP140","source":"Crossref","is-referenced-by-count":14,"title":["Osseocartilaginous Rib Graft L-Strut for Nasal Framework Reconstruction"],"prefix":"10.1093","volume":"40","author":[{"given":"Peter J","family":"Ciolek","sequence":"first","affiliation":[{"name":"Head and Neck Institute, Cleveland Clinic Foundation , Cleveland, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea L","family":"Hanick","sequence":"additional","affiliation":[{"name":"Head and Neck Institute, Cleveland Clinic Foundation , Cleveland, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Roskies","sequence":"additional","affiliation":[{"name":"University of Toronto , Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A","family":"Fritz","sequence":"additional","affiliation":[{"name":"Head and Neck Institute, Cleveland Clinic Foundation , Cleveland, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,7,1]]},"reference":[{"issue":"2","key":"2022122918514613900_CIT0001","doi-asserted-by":"crossref","first-page":"40e","DOI":"10.1097\/PRS.0b013e3181c82f12","article-title":"Current status of grafts and implants in rhinoplasty: part I. 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