Use of Bone-Cartilaginous Unit in Revision Rhinoplasty

Sazgar AA, Teimouri Y, Sazgar AK.

What this paper says

In 40 revision patients with insufficient septal cartilage, a composite graft of septal bone with attached cartilage improved the nasolabial angle and middle nasal third, with 85 percent reporting no or mild obstruction afterward.

Overview

Revision rhinoplasty frequently finds the septal cartilage already used up, forcing surgeons to harvest from the rib or ear, which takes time and carries donor site risks. This trial evaluated using the septal bone with its attached cartilage as a graft instead, avoiding a second surgical site.

Sections of note

Clinical trial of 40 patients with insufficient septal cartilage for grafting, referred to a tertiary center and a private setting from January 2016 to March 2017 for revision septorhinoplasty.
All patients had both nasal deformity and nasal obstruction.
Outcome assessment used anthropometric measurements, measurement of the middle nasal third width from photographs, and two questionnaires: NOSE and Rhinoplasty Outcome Evaluation.
Nasolabial angles and the middle nasal third improved significantly after surgery, P below 0.005.
On the NOSE questionnaire, 85 percent of patients had no or mild nasal obstruction after surgery.
On the ROE questionnaire, 62.5 percent were completely or very satisfied with the appearance of their nose.
The authors state the graft can be used in place of a rib graft and that harvesting it causes no morbidity and is not time consuming.

What it means for a patient

Bone from the septum, still attached to cartilage, can serve as a graft when the usable cartilage is gone.
This avoids a chest or ear incision and the recovery that comes with it.
Just under two thirds were completely or very satisfied with appearance, so roughly a third were not.
Limits: 40 patients, no comparison group against rib grafting, no stated follow-up duration, and no reported complication rate.

Why this paper matters

Graft shortage is the defining constraint of revision rhinoplasty, and rib harvest is its usual and costly solution. Using septal bone as a structural graft avoids that. Without a comparison arm the claim that it substitutes for rib cartilage is not directly tested.

Terms

Bone-cartilaginous unit: A composite graft of septal bone with its attached cartilage.
Composite graft: A graft made of more than one tissue type.
Conchal cartilage: Cartilage taken from the bowl of the ear.
Donor site morbidity: Problems caused at the place a graft was taken from.
Nasolabial angle: The angle between the base of the nose and the upper lip.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

From the abstract

“Insufficient septal cartilage is a common finding when performing revision rhinoplasty. Such cases require costal or conchal cartilage to be harvested, which is time consuming and brings the risk of morbidity. A new technique involves the use of a septal bone-cartilage composite graft or a bone-cartilaginous (BC) unit…”

Excerpt; the full abstract is on PubMed.