Supracrural Ligament Graft in Rhinoplasty

Overview

Visible bumps and ridges on the bridge or tip are a known risk after rhinoplasty, and patients with thin skin are considered more prone to them. Surgeons currently hide these with diced or crushed cartilage, temporalis fascia, fascia lata or processed donor skin. The authors describe the supracrural ligament graft, harvested during the initial exposure of the nose without any extra incision or additional dissection.

Sections of note

• Technique description with a series of 49 patients.
• The graft is harvested during the initial surgical exposure and requires no additional surgical site.
• Average graft size was 0.6 by 0.4 cm.
• The graft was used at the nasal tip in 49 percent of cases, at the radix in 40 percent, and on the nasal dorsum in 10 percent.
• No complications were seen in any of the 49 patients.
• The authors conclude routine harvest may remove the need for other grafting material or a second surgical site in thin skinned patients.

What it means for a patient

• The graft is soft tissue used to soften edges and hide irregularities, not to change the shape or support of the nose.
• Because it comes from tissue already exposed during the operation, it adds no second incision, no ear scar and no chest scar.
• Forty nine patients from one group with no comparison arm is limited evidence.
• The abstract states no follow up duration and no measure of whether irregularities were actually reduced.

Why this paper matters

Contour irregularities are among the commonest reasons for revision rhinoplasty in thin skinned patients, and every existing camouflage option costs either a second donor site or purchased material. This paper proposes using a structure the surgeon already has in hand. Whether it resists absorption over time is not reported.

Terms

• Camouflage graft: soft tissue laid over the framework to hide edges and irregularities.
• Supracrural ligament: a fibrous layer lying over the tip cartilages inside the nose.
• Radix: the root of the nose, at the top of the bridge between the eyes.
• Diced cartilage: cartilage cut into small pieces so it can be molded to a contour.
• Temporalis fascia: a tough sheet of tissue from the side of the head, used as a covering graft.
• AlloDerm: processed donor skin with the cells removed, used as a soft filler layer.