Auricular Composite Graft Survival in Rhinoplasty

Overview

An auricular composite graft takes skin and cartilage together from the ear and transplants them into the nose to rebuild defects of the internal nasal valve, the ala, the vestibule, the sill and the outer nose. The authors measured how often these grafts take and whether patients breathe better afterward. They reviewed charts of every rhinoplasty using such grafts performed by the senior author from 2002 to 2019.

Sections of note

• Design: retrospective chart review, single senior surgeon, 17 year span.
• Median patient age 42 years, range 14 to 79; 80.3 percent were women.
• 234 rhinoplasty procedures used 367 auricular composite grafts.
• Secondary rhinoplasty was the most common setting, 160 cases or 68.4 percent.
• 93.7 percent of grafts had full take; 23 grafts partially or totally failed, a 6.3 percent failure rate.
• Mean NOSE score was 24.08 before surgery and 21.84 after, a difference that was not statistically significant, p equal to 0.63.

What it means for a patient

• Grafts of ear skin plus cartilage survive in the nose in roughly nine of ten cases in this series.
• Breathing scores did not change significantly. The average starting score was already low, meaning mild symptoms, so there was little room to improve.
• Limits: one surgeon, no comparison group, retrospective records, and patient reported breathing measured with a single questionnaire.
• The stated percentages describe grafts, not patients, and one operation could use more than one graft.

Why this paper matters

Composite grafts are used when the nose is missing lining as well as support, most often in revision cases, and surgeons have had little published data on how often they survive. This series gives a survival figure from a large single surgeon experience. It does not establish which defects benefit most, nor whether an alternative reconstruction would do better.

Terms

• Auricular composite graft: a piece of ear containing skin and cartilage in one block, moved to the nose.
• Graft take: successful survival of transplanted tissue in its new site.
• Internal nasal valve: the narrowest part of the nasal airway, just inside the nose.
• Nasal vestibule: the space just inside the nostril, lined with skin.
• NOSE score: the Nasal Obstruction Symptom Evaluation questionnaire, where higher means worse blockage.
• Secondary rhinoplasty: surgery on a nose that has already been operated on.