Pectoralis major fascia in rhinoplasty

Overview

Fascia is used in rhinoplasty to smooth contours and to wrap cartilage grafts. The usual source is the deep temporalis fascia above the ear, which requires opening a separate surgical field and adds time and morbidity. The author points out that when costal cartilage is taken from the fifth to seventh ribs, the pectoralis major fascia must be cut through anyway to reach the cartilage.

Sections of note

• The argument is anatomical: pectoralis major fascia shares many physical and tissue characteristics with deep temporalis fascia.
• The fascia sits directly over the ribs used for cartilage harvest, so it is exposed as part of that approach.
• Taking it requires no additional incision, no separate sterile field and no extra positioning.
• The surgical technique for harvesting it is demonstrated in the paper.
• Two clinical cases are presented in which the fascia was harvested and used in the nose.
• Level of evidence 3. No series size, follow-up duration, complication rate or outcome measurements are reported in the abstract.

What it means for a patient

• This applies only to operations already planning to take cartilage from the ribs, typically major augmentation or revision surgery.
• It removes one incision and one scar from that operation, in the scalp.
• The evidence is two illustrative cases, not a series, so no rate of success or failure can be quoted.
• Whether chest fascia behaves the same way in the nose over years as temporalis fascia does is not tested here.

Why this paper matters

Donor site cost is a real part of the calculation in rhinoplasty, since each additional harvest adds scarring, time under anaesthetic and risk. Using tissue already exposed by another step is a straightforward reduction in that cost. The paper offers a technique description rather than evidence of equivalence.

Terms

• Fascia: a thin sheet of connective tissue that wraps muscles and other structures.
• Pectoralis major: the large chest muscle overlying the upper ribs.
• Deep temporalis fascia: the fascia over the chewing muscle at the side of the head, a common graft source.
• Costal cartilage: cartilage from the ribs, used as structural graft material in the nose.
• Augmentation rhinoplasty: nasal surgery that adds material to build up the nose.
• Morbidity: the harm or side effects caused by a procedure.