Y-Shaped En-Bloc Mortise-Tenon Rhinoplasty Technique

Overview

Setting the tip position in Asian rhinoplasty commonly uses a septal extension graft, but attaching it securely is the technical difficulty. This series describes a graft carved in one piece with an interlocking joint, borrowed from carpentry, that mounts onto the front edge of the septum.

Sections of note

• 278 consecutive Asian patients treated from July 2015 to December 2017: 95 primary, 173 secondary, and 10 tertiary deformities or patients wanting reshaping.
• Age range 19 to 46 years; 5 male and 273 female.
• In all cases the septal lining was dissected off the septal cartilage on both sides.
• The prepared en-bloc rib cartilage graft was mounted onto the front portion of the septal cartilage and fixed with 5-0 polydioxanone sutures.
• Follow-up ranged from 10 months to 2.5 years.
• External lengthening of the nose from root to tip ranged from 3 to 10 mm.
• All patients except one were satisfied with the shape of the nose. Level of evidence 4.

What it means for a patient

• The graft is cut with a slot so it fits onto the septum mechanically as well as being stitched, which is intended to stop it shifting.
• The nose was lengthened by up to 1 cm, which is the main change this graft delivers.
• Nearly two thirds of these patients were revision or third-time cases.
• Limits: 278 patients but one team, no comparison group, satisfaction reported without a stated measurement tool, and no complication or resorption data.

Why this paper matters

Septal extension grafts deviate or shift over time, which is a documented cause of later asymmetry, and mechanical interlocking addresses that directly. The case volume is large. Without complication rates or a comparison, whether the joint reduces deviation is not demonstrated.

Terms

• En bloc: In one continuous piece.
• Mortise and tenon: An interlocking joint where a projection fits into a matching slot.
• Septal extension graft: A cartilage piece attached to the septum and projecting forward to set tip position.
• Costal cartilage: Rib cartilage, used as a graft source.
• Mucoperichondrium: The lining layer covering septal cartilage.