Folded Cymba Concha: Is It Large and Stable Enough for Caudal Septal Extension Graft in Asian Rhinoplasty?

Overview

Septal extension grafts set the projection and position of the nasal tip, but the authors state Asian patients often lack sufficient septal cartilage, and in most repeat operations the septum has already been harvested. They used a folded piece of ear cartilage, the cymba concha, as an alternative, modifying a tongue in groove technique. The study assessed whether that cartilage is physically suitable and compared its results with septal cartilage.

Sections of note

• Mean length and width of 311 consecutive folded cymba conchae were measured from intraoperative photographs.
• Clinical outcomes were reviewed retrospectively in 220 patients with more than 12 months of follow up.
• Mean folded length was 24.2 mm in men and 22.4 mm in women; mean width was 7.8 mm and 7.2 mm respectively.
• Clinical demography was assessed based on the need for additional spreader grafts.
• The folded graft increased nasal tip projection by 28.9 percent and the columellar labial angle by 9.7 percent.
• Photographic comparison found no significant difference against septal cartilage for tip projection, P equals 0.264, or columellar labial angle, P equals 0.182.
• The authors conclude it can be a primary option where septal cartilage is insufficient.

What it means for a patient

• Ear cartilage can be used to support the tip when the septum is unavailable, avoiding a rib harvest and chest scar.
• Folding the ear cartilage is what gives it the stiffness a straight strut needs.
• The comparison used photographic measurements rather than a randomized design.
• The abstract reports no complication rate and no measure of whether the graft held its position beyond the measured points.

Why this paper matters

Cartilage supply limits what is possible in revision and in Asian augmentation rhinoplasty, and the choice is usually between ear, rib and donor cartilage. This study shows ear cartilage can match septal cartilage on two measurable tip outcomes. Long term stability of the folded graft remains the open question.

Terms

• Cymba concha: the upper hollow of the ear bowl, a source of curved cartilage.
• Caudal septal extension graft: cartilage attached to the front lower septum to set the tip position.
• Quadrangular cartilage: the main flat plate of septal cartilage.
• Tongue in groove: a technique sliding the tip cartilages onto the septal graft.
• Columellar labial angle: the angle between the base of the nose and the upper lip.