Post-Traumatic Nasal Pyramid Reconstruction with a Custom-Made Titanium Implant: A Case Report with Ultrastructural Evaluation

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.