A modified technique of septal extension using a septal cartilage graft for short-nose rhinoplasty in Asians

Overview

A short nose is common in Asians, and Chinese rhinoplasty had long relied on synthetic implants for the bridge. Using implants at the tip or to lengthen the nose carries a high complication risk, so surgeons turned to the patient's own cartilage. Septal cartilage is scarce in these patients; the authors describe a way to get a strong extension from a small amount.

Sections of note

• 113 Chinese patients (101 women, 12 men), January 2008 to February 2012, with short noses, saddle noses and/or round tips; open rhinoplasty.
• Dorsal augmentation with silicone in 29 and ePTFE in 84.
• Harvestable septal cartilage carved into "a" and "b" strips sutured into a V-shaped structure to extend the septum; ear cartilage added when needed.
• Nasal length, tip projection and nasolabial angle measured before and after in 53 cases.
• 78 patients followed for a mean of 15 months (range 1 month to 3 years).
• No major implant complications; 6 silicone dorsum cases had an operated look.
• Nasal length and tip projection increased significantly (p < 0.05); nasolabial angle trended lower without significance.
• Level of evidence V.

What it means for a patient

• A short nose can be lengthened with the patient's own septal cartilage even when there is not much of it, by joining two strips into a stronger V.
• The bridge in these patients was still raised with a synthetic implant.
• Only 78 of 113 had follow-up, some as short as 1 month; single center, no comparison group.

Why this paper matters

Septal extension grafts became the workhorse of Asian tip surgery, and cartilage supply is the limiting factor. This paper shows a construct that economizes septal cartilage. Long-term stability of the V-shaped extension is not established.

Terms

• Septal extension graft: cartilage fixed to the front edge of the septum to push the tip forward or downward.
• Short nose: a nose whose length from root to tip is too small for the face, often with an upturned tip.
• Saddle nose: a sunken bridge from loss of septal support.
• ePTFE: expanded polytetrafluoroethylene, a porous synthetic implant.
• Tip projection: how far the tip stands out from the face.
• Nasolabial angle: the angle between the columella and the upper lip, a measure of tip rotation.