Rhinoplasty with Mortise-Tenon Cartilaginous Framework for Caudal Septal Cartilage Defects

Zhang X, Song Z, Xu Y, Zheng R, Tian L, Guo J, Wang H, You J, Fan F.

What this paper says

Seventeen patients missing cartilage from the front lower septum were rebuilt with a rib cartilage framework joined by an interlocking mortise and tenon design, with no complications over an average 22.4 months.

Overview

The caudal septum is the front lower edge of the wall dividing the nose, and it carries the tip. When cartilage there is missing, rebuilding it is difficult because grafts are hard to fix securely in a mobile area. The authors adapted the mortise and tenon joint, a woodworking method in which a projection on one piece slots into a cavity in another, to lock rib cartilage pieces together.

Sections of note

Design: retrospective analysis of consecutive patients treated by one senior surgeon, May 2019 to May 2022. Level of evidence IV.
17 patients, ages 27 to 58.
Average follow up: 22.4 months.
Graft material: costal cartilage, taken from the ribs.
No short term or long term complications were observed.
The aesthetic outcome was described as satisfactory in all cases.
Mean patient rating of improvement in their nose: 8.11, with no scale range stated in the abstract.

What it means for a patient

The interlocking design addresses fixation, which is the practical problem when the septum's front edge has to be rebuilt from scratch.
Follow up averaged nearly two years, longer than many technique reports, and no complications occurred within that time.
Limits: 17 patients, one surgeon, retrospective, no comparison group, and satisfaction reported as a single number without the scale it was measured on.
Using rib means a chest incision, which the abstract does not discuss.

Why this paper matters

Loss of caudal septal cartilage, whether from trauma, prior surgery or disease, undermines both tip support and the airway, and reconstructions there frequently loosen or shift. A mechanical joint rather than sutures alone is a direct answer to that. Whether the framework holds over many years, and how it compares with conventional extension grafts, is unanswered.

Terms

Caudal septum: the front lower edge of the wall dividing the two sides of the nose.
Costal cartilage: cartilage from the ribs, harvested for use as a graft.
Mortise and tenon: a joint where a projection on one piece fits into a matching cavity in another.
Cartilaginous framework: the assembled cartilage scaffold supporting the nose.
Retrospective analysis: review of records of care already delivered.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

From the abstract

“Rhinoplasty for caudal septal cartilage defects is a challenge due to the difficulty of fixation of the grafts. Objectives: This study presents an approach for correcting defects in caudal septal cartilage with the costal cartilaginous framework using a mortise-tenon technique. Methods: From May 2019 through May 2022,…”

Excerpt; the full abstract is on PubMed.