Use of Mastoid Periosteum Graft in Primary and Revision Rhinoplasty

Overview

Building up or smoothing the bridge and the root of the nose needs a material that does not show through the skin. The authors began using periosteum, the membrane covering bone, harvested from behind the ear. This retrospective review reports the technique and its outcomes in first-time and revision surgery.

Sections of note

• Medical records of 62 patients who had rhinoplasty with mastoid periosteum were reviewed retrospectively.
• 21 patients with follow-up beyond 6 months were analyzed by comparing before and after photographs.
• Two independent surgeons scored aesthetic results 0 to 4, from poor to excellent.
• The graft was used in 32 primary and 30 revision cases.
• Sites grafted: radix in 28 cases, dorsum in 15, both in 19.
• A cartilage underlay was combined with the periosteum graft in 38 patients (61.3%).
• Mean aesthetic score was 2.8 overall, 3.2 in primary and 2.4 in revision cases; cartilage-combined cases scored 3.1 versus 2.5 for free graft alone. Three cases of partial graft resorption occurred with no major complications. Level of evidence IV.

What it means for a patient

• The membrane covering bone behind the ear can be used to smooth or build up the bridge, avoiding a chest or septal harvest.
• Results were better in first-time surgery than revision, and better when cartilage was placed under the periosteum.
• Partial shrinkage of the graft occurred in 3 patients, and the authors state long-term resorption cannot be excluded.
• Limits: 62 treated but only 21 assessed, retrospective, no comparison group, and outcome scored from photographs by surgeons rather than reported by patients.

Why this paper matters

Camouflage material for the bridge is a recurring need, and each donor site carries its own trade-offs. Periosteum from behind the ear is easy to reach with a hidden scar. Whether the graft holds volume beyond a year is the question the authors themselves leave open.

Terms

• Periosteum: The living membrane wrapping bone.
• Mastoid: The bony prominence behind the ear.
• Radix: The root of the nose, the deepest point between the eyes.
• Dorsum: The bridge of the nose.
• Underlay graft: A graft placed beneath another layer to add bulk.
• Resorption: Gradual absorption and shrinkage of a graft by the body.