Optimizing the Septal Donor Site in Asian Rhinoplasty: A Computed Tomography-Based Simulation of the Bony-Cartilaginous Unit and Skull Base Safety

Nguyen CD, Chau DN, Nguyen HQ, Nguyen TT.

PubMed 42303768 Publisher (DOI)Free full text (PMC)

What this paper says

CT scans of 116 Asian adults showed a harvestable septal cartilage area of only 461.5 mm2 after leaving a 10 mm L-strut, but including the bony septum raised it to 992.0 mm2, a 2.21-fold gain, with skull-base landmarks defined for safe harvest.

Overview

Asian rhinoplasty needs strong grafts to push against thick skin, and the septum alone often runs out. The Vietnamese authors virtually executed a standardised harvest on CT scans of 116 adults (60 men, 56 women), preserving a 10 mm L-strut, and measured total septal area, harvestable cartilage, and the composite unit including the perpendicular plate of the ethmoid and vomer. They also measured distances to skull-base structures.

Sections of note

Harvestable cartilage: mean 461.5 mm2, significantly less in women (p < 0.001).
Composite bony-cartilaginous area: 992.0 mm2, 2.21 times the cartilage alone.
Mean skull base angle 123.6 degrees.
Distance from anterior nasal spine to cribriform plate 48.9 mm; to anterior sphenoid wall 54.3 mm.
Level of Evidence III.

What it means for a patient

In Asian patients, especially women, the septum alone often cannot supply enough graft, which is why rib or ear cartilage is so often used.
Taking part of the bony septum can double the supply and avoid a second donor site.
The bony septum sits close to the skull base, so this harvest needs precise limits; the paper supplies them.

Why this paper matters

It quantifies septal graft supply in an Asian population and maps the safety margins for extended harvest. Limits: imaging simulation, not surgical outcomes; single population.

Terms

L-strut: the L-shaped rim of septal cartilage left in place to keep the nose supported.
Perpendicular plate of the ethmoid: the thin bone forming the upper back septum.
Vomer: the bone forming the lower back septum.
Cribriform plate: the perforated skull-base bone above the nose through which smell nerves pass.
Composite graft: here, cartilage and bone harvested together as one piece.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

Abstract

Background: Asian rhinoplasty frequently requires robust structural support to counteract a thick skin envelope. However, relying solely on septal cartilage often leads to graft depletion after preserving a safety L-strut. This study quantifies the volumetric sufficiency of the composite bony-cartilaginous unit to address this limitation while ensuring skull base safety.

Methods: A retrospective computed tomography analysis was performed on 116 Asian adults (60 men, 56 women). A standardized harvest template was virtually executed, assuming the preservation of a 10-mm L-strut. Total septal area, harvestable cartilage, and the composite bony-cartilaginous unit (cartilage, perpendicular plate of the ethmoid, and vomer) were quantified using defined anatomical landmarks.

Results: The harvestable septal cartilage averaged 461.5 mm2, which was significantly smaller in women than in men (p < 0.001). Expanding the harvest to include the bony septum yielded a composite area of 992.0 mm2, representing a 2.21-fold increase in graft availability. Radiographic analysis established critical safety landmarks: the mean skull base angle was 123.6°, the distance from the anterior nasal spine to the cribriform plate was 48.9 mm, and the distance to the anterior sphenoid wall was 54.3 mm.

Conclusions: Septal cartilage is an inherently scarce resource in Asian rhinoplasty, particularly in females. Harvesting the septum as a bony-cartilaginous unit safely and reliably doubles the graft supply. With precise osteotomy trajectories, this composite graft eliminates the need for distant donor site morbidity, serving as an optimal local reserve.

Level Of Evidence Iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract as indexed by PubMed; the article is open access (PubMed Central).