A Modified Technique in Rhinoplasty: A Septal Extension Graft Complex Using Septal Cartilage, Ethmoid Bone, and Auricular Cartilage

Overview

Asian septal cartilage is small and weak, making it hard to achieve the intended tip projection and lengthening with a septal extension graft of septal cartilage alone. The authors add the perpendicular plate of the ethmoid bone and ear cartilage, and examine the result for shape and mechanical support.

Sections of note

• Study of 25 patients, followed a mean of 25.9 months.
• Septal cartilage was harvested under endoscopic view using standard techniques.
• Two pieces of ethmoid bone were placed either side of the L-shaped strut as spreader grafts.
• A double layer of ear cartilage was fixed as a columellar strut.
• Three dimensional scanning measured shape; tip resistance was measured with a digital force meter.
• Nasal length rose from 41.4 plus or minus 4.0 to 46.2 plus or minus 3.4 mm, P less than 0.05.
• Tip projection rose from 21.3 to 24.4 mm and the nasolabial angle fell from 117.6 to 109.5 degrees, both P less than 0.05.
• Tip resistance increased significantly at 1, 2 and 3 mm displacement; all patients were satisfied and no serious complications occurred.

What it means for a patient

• The graft combines three materials, using bone for rigidity and ear cartilage for the tip support post.
• Tip firmness was measured with a force meter rather than assessed by feel.
• Twenty five patients with no comparison group is limited evidence.
• Measured firmness is not necessarily desirable; a rigid tip is a known complaint after such grafting.

Why this paper matters

Short nose correction in East Asian patients is limited by the amount and strength of septal cartilage available. This technique substitutes bone and ear cartilage for what the septum cannot supply, with objective measurement of both shape and support. Whether the added rigidity affects how the tip feels was not assessed.

Terms

• Septal extension graft: cartilage attached to the septum to set the position and projection of the tip.
• Perpendicular plate of the ethmoid: the thin bone forming the upper rear part of the septum.
• Auricular cartilage: cartilage taken from the ear.
• L-strut: the L-shaped portion of septum left to support the bridge and tip.
• Spreader graft: a strip placed beside the septum to widen the internal breathing valve.
• Columellar strut: a cartilage post between the nostrils supporting the tip.