Sphenoidal process of septal cartilage: Useful autologous graft option in revision rhinoplasty

Abstract Background Insufficient septal cartilage is a common finding when performing revision rhinoplasty. Such cases require costal or conchal cartilage to be harvested, which is time consuming and brings the risk of morbidity. A new technique involves the use of a septal bone-cartilage composite graft or a bone-cartilaginous (BC) unit as a rhinoplasty graft. Objectives The aim of this research was to evaluate the subjective and objective effects of using a BC unit graft in revision rhinoplasty. Methods In this clinical trial, we examined 40 patients with insufficient septal cartilage for grafting who were referred to a tertiary center and a private setting from January 2016 to March 2017 for revision septorhinoplasty. The patients had nasal deformity and nasal obstruction. Assessment of surgical outcome was based on anthropometric measurements and by measuring the width of the middle nasal third from photographs, and on 2 patient questionnaires: the Nasal Obstruction and Septoplasty Effectiveness (NOSE) and the Rhinoplasty Outcome Evaluation (ROE) questionnaires. Results Nasolabial angles and the middle nasal third improved significantly after surgery (P < 0.005). Based on the NOSE questionnaire, 85% of patients had no or mild nasal obstruction, and the ROE questionnaire indicated that 62.5% were completely or very satisfied with the appearance of their nose. Conclusions The BC unit is an effective graft in revision rhinoplasty, and can be used in place of the rib graft. In skilled hands, harvesting of this graft results in no morbidity and is not time consuming. Level of Evidence: 4

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Growth of the face and jaws after resection of the septal cartilage in the rabbit

American Journal of Anatomy ◽

10.1002/aja.1001180306 ◽

1966 ◽

Vol 118 (3) ◽

pp. 755-767 ◽

Cited By ~ 96

Author(s):

Bernard G. Sarnat ◽

Manuel R. Wexler

Keyword(s):

Septal Cartilage ◽

The Face

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Costal Cartilage Lateral Crural Strut Graft for Correction of External Nasal Valve Dysfunction in Primary and Revision Rhinoplasty

Ear Nose & Throat Journal ◽

10.1177/0145561320983940 ◽

2021 ◽

pp. 014556132098394

Author(s):

Mohamed A. Taha ◽

Christian A. Hall ◽

Harry E. Zylicz ◽

William T. Barham ◽

Margaret B. Westbrook ◽

...

Keyword(s):

Costal Cartilage ◽

Primary Group ◽

Nasal Valve ◽

Lateral Crus ◽

Valve Dysfunction ◽

Score Improvement ◽

Revision Rhinoplasty ◽

Final Score ◽

Sinonasal Outcome Test ◽

External Nasal Valve

Objective: To evaluate and compare the costal cartilage lateral crural strut graft’s (LCSG) ability to support a weak lateral crus in patients with external nasal valve dysfunction (EVD) undergoing primary versus revision functional rhinoplasty. Methods: This is a prospective cohort study of 26 patients (mean [SD]: 40.23 [6.75] years of age; 10 [38%] females) with clinically diagnosed EVD, who underwent primary versus revision functional rhinoplasty with the use of a costal cartilage LCSG (10 [38%] primary functional rhinoplasty patients and the 16 [62%] revision patients). Preoperative and 12-month postoperative subjective and objective functional measurements along with statistical analysis were performed. Results: While all baseline demographic and preoperative functional measurement scores were similar between the 2 groups, the primary cohort’s preoperative scores were higher overall. Follow-up was a mean of 14.58 months. The primary group demonstrated a greater difference in score improvement postoperatively in all categories. All patients had significantly improved visual analog scale (VAS), Nasal Obstruction Symptom Evaluation Scale, 22-Item Sinonasal Outcome Test, and nasal peak inspiratory flow (NPIF) scores. When comparing the overall score outcome and surgical efficacy of the LCSG, both groups had near equal final score outcomes with the exception of VASL and NPIF. Conclusion: The LCSG is a viable and versatile option in the management of EVD for both primary and revision rhinoplasty patients.

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The Deviated Nose and the Nasal Airway

Journal of the Royal Society of Medicine ◽

10.1177/014107687907201112 ◽

1979 ◽

Vol 72 (11) ◽

pp. 848-851

Author(s):

A G D Maran

Keyword(s):

Airway Obstruction ◽

Experimental Work ◽

Septal Cartilage ◽

Nasal Airway ◽

Deviated Nose ◽

Bony Segment ◽

Submucous Resection ◽

And Cartilage ◽

Valve Area ◽

Taking Care

The pathology of the deviated nose is discussed in relation to its bony and cartilaginous components. The importance of the interlocking stresses within the septal cartilage is pointed out especially with respect to continuing deformation after trauma. The methods of rhinometry are analysed and normal airflow through the nose is described. The effects on the nasal airway of a caudal dislocation of the septum, an angulation at the valve area, a high septal deflection and an excessively wide choana are discussed. In the treatment of a deviated bony segment the difficulties of medial and lateral osteotomies are described. The indications for a septoplasty are thought to be a dislocated caudal end, a tip deviation and an external lateral angulation. The submucous resection of the septum should be reserved for resolved haematoma and cartilage absorption. The importance of the patient's priorities in deciding what operation to do are pointed out. Finally the experimental work on the effect of cartilage and mucoperichondrium resection on nasal growth is reviewed. It is suggested that a child with a severe septal deflection and airway obstruction should be offered a septoplasty taking care not to damage the mucoperichondrium.

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