Post-Traumatic Nasal Pyramid Reconstruction with a Custom-Made Titanium Implant: A Case Report with Ultrastructural Evaluation.
6 affiliations
- 1University General Hospital "Attikon", National and Kapodistrian University of Athens, 12462 Athens, Greece.
- 2Laboratory of Histology-Embryology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece.
- 3Research Team "Histologistas", Interinstitutional Postgraduate Program "Health and Environmental Factors", Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece.
- 4Department of Neurosurgery, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece.
- 53rd Department of General Surgery, University General Hospital "AHEPA", Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece.
- 6Clinic of Plastic and Reconstructive Surgery, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece.
Abstract
Background/Objectives: Post-traumatic nasal pyramid reconstruction is challenging in patients with severe deformity and exhausted autologous graft options, particularly after multiple failed surgeries. Custom-made titanium implants may offer precise structural support, but data on their mucosal integration and ultrastructural tissue response in nasal reconstruction are lacking. The aim of this study is to describe what is, to the best of our knowledge, the first reported case of nasal pyramid reconstruction using an IPS (Individual Patient Solutions) custom-made titanium implant and to evaluate peri-implant tissue response with transmission electron microscopy (TEM). Methods: A 50-year-old male military personnel with long-standing saddle-nose deformity, nasal obstruction, and prior failed graft-based reconstructions underwent open rhinoplasty with placement of a patient-specific titanium implant designed with three-dimensional virtual surgical planning on the basis of established nasal anthropometric parameters and manufactured as a custom-made device under Regulation (EU) 2017/745. The implant reconstructed the nasal dorsum from nasion to tip and was stabilized with cortical screws; an additional thin titanium plate was used for tip support. Biopsies of nasal mucosa and adjacent connective tissue obtained 24 months postoperatively were processed for TEM to assess epithelial, stromal, vascular, and implant-tissue interface characteristics. Results: Clinically, nasal airway patency improved immediately after packing removal, with restoration of nasal contour and stable functional and aesthetic outcomes at 24-month follow-up without complications. Ultra-structurally, the respiratory epithelium showed preserved stratification, intact basal and ciliated cells, normal nuclei and mitochondria, and organized extracellular matrix closely opposed to discrete titanium particles, without granulomatous foreign-body reaction, dense inflammatory infiltrate, or fibrotic encapsulation. Focal ciliary damage, cytoplasmic vacuolization, lamina propria thickening, and vascular elastic lamina remodeling were interpreted as adaptive or transient stress-related changes rather than chronic implant toxicity. Conclusions: Custom-made IPS titanium implants can provide stable structural support, satisfactory functional and aesthetic outcomes, and a well-tolerated mucosal interface in complex post-traumatic nasal pyramid reconstruction after failed graft-based surgeries. The ultrastructural findings are being consistent with good local tolerance of the implant at 24 months, showing predominantly preserved epithelial and stromal architecture with only focal, adaptive stress-related changes rather than chronic implant-related toxicity. However, as this is a single case assessed without conventional histology, immunohistochemistry or objective measurement of nasal airflow, these observations cannot establish biocompatibility, efficacy or long-term safety, and require confirmation in larger series with longer follow-up.
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BibTeX
@article{chatzistefanou2026posttraumatic,
title = {{Post-Traumatic Nasal Pyramid Reconstruction with a Custom-Made Titanium Implant: A Case Report with Ultrastructural Evaluation.}},
author = {Ioannis Chatzistefanou and Sophia Tsokkou and Sofia Karachrysafi and Kyriaki Papadopoulou and Ioannis Konstantinidis and Alexandros C Liatsos and Vasiliki Theodorou and Antonia Sioga and Georgia-Alexandra Spyropoulou and Vasileios Petsinis and Theodora Papamitsou},
journal = {Clinics and practice},
year = {2026},
month = oct,
doi = {10.3390/clinpract16100188},
url = {https://europepmc.org/article/MED/42930374},
note = {CC BY},
}
RIS
TY - JOUR
TI - Post-Traumatic Nasal Pyramid Reconstruction with a Custom-Made Titanium Implant: A Case Report with Ultrastructural Evaluation.
AU - Ioannis Chatzistefanou
AU - Sophia Tsokkou
AU - Sofia Karachrysafi
AU - Kyriaki Papadopoulou
AU - Ioannis Konstantinidis
AU - Alexandros C Liatsos
AU - Vasiliki Theodorou
AU - Antonia Sioga
AU - Georgia-Alexandra Spyropoulou
AU - Vasileios Petsinis
AU - Theodora Papamitsou
PY - 2026
DA - 2026/10/10
JO - Clinics and practice
DO - 10.3390/clinpract16100188
UR - https://europepmc.org/article/MED/42930374
AB - Background/Objectives: Post-traumatic nasal pyramid reconstruction is challenging in patients with severe deformity and exhausted autologous graft options, particularly after multiple failed surgeries. Custom-made titanium implants may offer precise structural support, but data on their mucosal integration and ultrastructural tissue response in nasal reconstruction are lacking. The aim of this study is to describe what is, to the best of our knowledge, the first reported case of nasal pyramid reconstruction using an IPS (Individual Patient Solutions) custom-made titanium implant and to evaluate peri-implant tissue response with transmission electron microscopy (TEM). Methods: A 50-year-old male military personnel with long-standing saddle-nose deformity, nasal obstruction, and prior failed graft-based reconstructions underwent open rhinoplasty with placement of a patient-specific titanium implant designed with three-dimensional virtual surgical planning on the basis of established nasal anthropometric parameters and manufactured as a custom-made device under Regulation (EU) 2017/745. The implant reconstructed the nasal dorsum from nasion to tip and was stabilized with cortical screws; an additional thin titanium plate was used for tip support. Biopsies of nasal mucosa and adjacent connective tissue obtained 24 months postoperatively were processed for TEM to assess epithelial, stromal, vascular, and implant-tissue interface characteristics. Results: Clinically, nasal airway patency improved immediately after packing removal, with restoration of nasal contour and stable functional and aesthetic outcomes at 24-month follow-up without complications. Ultra-structurally, the respiratory epithelium showed preserved stratification, intact basal and ciliated cells, normal nuclei and mitochondria, and organized extracellular matrix closely opposed to discrete titanium particles, without granulomatous foreign-body reaction, dense inflammatory infiltrate, or fibrotic encapsulation. Focal ciliary damage, cytoplasmic vacuolization, lamina propria thickening, and vascular elastic lamina remodeling were interpreted as adaptive or transient stress-related changes rather than chronic implant toxicity. Conclusions: Custom-made IPS titanium implants can provide stable structural support, satisfactory functional and aesthetic outcomes, and a well-tolerated mucosal interface in complex post-traumatic nasal pyramid reconstruction after failed graft-based surgeries. The ultrastructural findings are being consistent with good local tolerance of the implant at 24 months, showing predominantly preserved epithelial and stromal architecture with only focal, adaptive stress-related changes rather than chronic implant-related toxicity. However, as this is a single case assessed without conventional histology, immunohistochemistry or objective measurement of nasal airflow, these observations cannot establish biocompatibility, efficacy or long-term safety, and require confirmation in larger series with longer follow-up.
SN - 2039-7275
SN - 2039-7283
ER -