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Facial Plast Surg 2023; 39(04): 408-416
DOI: 10.1055/s-0042-1760296
Original Article

A Novel Ear Cartilage Caudal Septal Extension Graft

Hossam M.T. Foda
1   Department of Otolaryngology, Alexandria Medical School, Alexandria, Egypt
,
Ahmed El Abany 
2   Department of Maxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Abstract

In cases of weak or deficient caudal septum, the caudal septum extension graft (CSEG) is the most commonly used reconstructive method. In the current study we introduce a newly-designed conchal cartilage CSEG and evaluate its cosmetic and functional outcomes. The graft has an average length of 3 ± 0.3 cm and composed of a distal double-layered part, which is 3 to 4 mm wide and a proximal single-layered part, which is 1.2 to 1.7 cm wide. The graft design allows the proximal single-layered part to be fixed on either sides of the caudal septum while keeping the distal double-layered segment in the midline. The study included 230 patients, of which 83% were revisions, all patients completed a validated patient-reported outcome measure (PROM) questionnaire pre- and postoperatively. The PROMs used were either the Nasal Obstruction Symptom Evaluation (NOSE) survey or the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS). During the mean follow-up period of 18.2 months (range: 9–192 months) no serious complications were encountered and only six cases (2.3%) required minor revisions of the CSEG.

Using the proposed conchal cartilage, CSEG resulted in an improved cosmetic and functional outcome as evidenced by the significant postoperative improvement in the NOSE, SCHNOS-O, and SCHNOS-C scores with a p-value <0.001, <0.05, and <0.0001, respectively. The graft provided adequate tensile strength and support to the nasal tip, which resulted in improved tip projection, rotation, definition, and symmetry, while maintaining a degree of flexibility and elasticity which is much more than that of the rib or even the septum thus resulting in the most natural feel of the nasal tip lobule.

Keywords

ear cartilage - nose - septum extension graft - rhinoplasty


Publication History

Article published online:
11 January 2023

© 2023. Thieme. All rights reserved.

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  • References

  • 1 Westreich RW, Courtland HW, Nasser P, Jepsen K, Lawson W. Defining nasal cartilage elasticity: biomechanical testing of the tripod theory based on a cantilevered model. Arch Facial Plast Surg 2007; 9 (04) 264-270
    CrossrefPubMedGoogle Scholar
  • 2 Shamouelian D, Leary RP, Manuel CT, Harb R, Protsenko DE, Wong BJ. Rethinking nasal tip support: a finite element analysis. Laryngoscope 2015; 125 (02) 326-330
    CrossrefPubMedGoogle Scholar
  • 3 Foda HMT. The caudal septum replacement graft. Arch Facial Plast Surg 2008; 10 (03) 152-157
    CrossrefPubMedGoogle Scholar
  • 4 Byrd HS, Andochick S, Copit S, Walton KG. Septal extension grafts: a method of controlling tip projection shape. Plast Reconstr Surg 1997; 100 (04) 999-1010
    CrossrefPubMedGoogle Scholar
  • 5 Toriumi DM. Caudal septal extension graft for correction of the retracted columella. Oper Tech Otolaryngol–Head Neck Surg 1995; 6: 311-318
    CrossrefPubMedGoogle Scholar
  • 6 Holden PK, Liaw LH, Wong BJ. Human nasal cartilage ultrastructure: characteristics and comparison using scanning electron microscopy. Laryngoscope 2008; 118 (07) 1153-1156
    CrossrefPubMedGoogle Scholar
  • 7 Bos EJ, Pluemeekers M, Helder M. et al. Structural and mechanical comparison of human ear, alar, and septal cartilage. Plast Reconstr Surg Glob Open 2018; 6 (01) e1610
    CrossrefPubMedGoogle Scholar
  • 8 Falces E, Gorney M. Use of ear cartilage grafts for nasal tip reconstruction. Plast Reconstr Surg 1972; 50 (02) 147-152
    CrossrefPubMedGoogle Scholar
  • 9 Muenker R. The bilateral conchal cartilage graft: a new technique in augmentation rhinoplasty. Aesthetic Plast Surg 1984; 8 (01) 37-42
    CrossrefPubMedGoogle Scholar
  • 10 Stucker FJ, Hoasjoe DK. Nasal reconstruction with conchal cartilage. Correcting valve and lateral nasal collapse. Arch Otolaryngol Head Neck Surg 1994; 120 (06) 653-658
    CrossrefPubMedGoogle Scholar
  • 11 Pirsig W, Kern EB, Verse T. Reconstruction of anterior nasal septum: back-to-back autogenous ear cartilage graft. Laryngoscope 2004; 114 (04) 627-638
    CrossrefPubMedGoogle Scholar
  • 12 Pedroza F, Anjos GC, Patrocinio LG, Barreto JM, Cortes J, Quessep SH. Seagull wing graft: a technique for the replacement of lower lateral cartilages. Arch Facial Plast Surg 2006; 8 (06) 396-403
    CrossrefPubMedGoogle Scholar
  • 13 Murrell GL. Auricular cartilage grafts and nasal surgery. Laryngoscope 2004; 114 (12) 2092-2102
    CrossrefPubMedGoogle Scholar
  • 14 Toncic R, Toncic D. Sublabial autologous ear cartilage grafting for increasing the nasolabial angle. Arch Plast Surg 2016; 43 (01) 46-52
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Pascali M, Gentile P, Di Pasquali C, Bocchini I, Cervelli V. The auricular cartilage in 197 secondary and tertiary rhinoplasties. J Craniofac Surg 2016; 27 (02) 339-344
    CrossrefPubMedGoogle Scholar
  • 16 Stewart MG, Smith TL, Weaver EM. et al. Outcomes after nasal septoplasty: results from the Nasal Obstruction Septoplasty Effectiveness (NOSE) study. Otolaryngol Head Neck Surg 2004; 130 (03) 283-290
    CrossrefPubMedGoogle Scholar
  • 17 Moubayed SP, Ioannidis JPA, Saltychev M, Most SP. The 10-Item Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) for functional and cosmetic rhinoplasty. JAMA Facial Plast Surg 2018; 20 (01) 37-42
    CrossrefPubMedGoogle Scholar
  • 18 Foda HMT. External rhinoplasty: a critical analysis of 500 cases. J Laryngol Otol 2003; 117 (06) 473-477
    CrossrefPubMedGoogle Scholar
  • 19 Manuel CT, Leary R, Protsenko DE, Wong BJ. Nasal tip support: a finite element analysis of the role of the caudal septum during tip depression. Laryngoscope 2014; 124 (03) 649-654
    CrossrefPubMedGoogle Scholar
  • 20 Willson TJ, Swiss T, Barrera JE. Quantifying changes in nasal tip support. JAMA Facial Plast Surg 2015; 17 (06) 428-432
    CrossrefPubMedGoogle Scholar
  • 21 Zalzal GH, Cotton RT, McAdams AJ. Cartilage grafts–present status. Head Neck Surg 1986; 8 (05) 363-374
    CrossrefPubMedGoogle Scholar
  • 22 Collawn SS, Fix RJ, Moore JR, Vasconez LO. Nasal cartilage grafts: more than a decade of experience. Plast Reconstr Surg 1997; 100 (06) 1547-1552
    CrossrefPubMedGoogle Scholar
  • 23 Vuyk HD, Adamson PA. Biomaterials in rhinoplasty. Clin Otolaryngol Allied Sci 1998; 23 (03) 209-217
    CrossrefPubMedGoogle Scholar
  • 24 Khurana D, Sherris D. Grafting materials for augmentation septorhinoplasty. Curr Opin Otolaryngol Head Neck Surg 1999; 7: 210-213
    CrossrefPubMedGoogle Scholar
  • 25 Cárdenas-Camarena L, Guerrero MT. Use of cartilaginous autografts in nasal surgery: 8 years of experience. Plast Reconstr Surg 1999; 103 (03) 1003-1014
    CrossrefPubMedGoogle Scholar
  • 26 Parker Porter J. Grafts in rhinoplasty: alloplastic vs. autogenous. Arch Otolaryngol Head Neck Surg 2000; 126 (04) 558-561
    CrossrefPubMedGoogle Scholar
  • 27 Quatela VC, Jacono AA. Structural grafting in rhinoplasty. Facial Plast Surg 2002; 18 (04) 223-232
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Cervelli V, Bottini DJ, Gentile P. et al. Reconstruction of the nasal dorsum with autologous rib cartilage. Ann Plast Surg 2006; 56 (03) 256-262
    CrossrefPubMedGoogle Scholar
  • 29 Toriumi DM. Autogenous grafts are worth the extra time. Arch Otolaryngol Head Neck Surg 2000; 126 (04) 562-564
    CrossrefPubMedGoogle Scholar
  • 30 Neu BR. Combined conchal cartilage-ethmoid bone grafts in nasal surgery. Plast Reconstr Surg 2000; 106 (01) 171-175
    CrossrefPubMedGoogle Scholar
  • 31 Parkes ML, Kamer FM. The mature nose. Laryngoscope 1973; 83 (02) 157-166
    CrossrefPubMedGoogle Scholar
  • 32 Romo III T, Soliemanzadeh P, Litner JA, Sclafani AP. Rhinoplasty in the aging nose. Facial Plast Surg 2003; 19 (04) 309-315
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Gruber RP, Nahai F, Bogdan MA, Friedman GD. Changing the convexity and concavity of nasal cartilages and cartilage grafts with horizontal mattress sutures: part I. Experimental results. Plast Reconstr Surg 2005; 115 (02) 589-594
    CrossrefPubMedGoogle Scholar
  • 34 Boccieri A. Subtotal reconstruction of the nasal septum using a conchal reshaped graft. Ann Plast Surg 2004; 53 (02) 118-125
    CrossrefPubMedGoogle Scholar
  • 35 Peck GC, Guzman CI, Hoefflin SM, Ofodile F. The non-Caucasian nose. Aesthet Surg J 2002; 22 (04) 371-377
    CrossrefPubMedGoogle Scholar
  • 36 Echeverry A, Carvajal J, Medina E. Alternative technique for tip support in secondary rhinoplasty. Aesthet Surg J 2006; 26 (06) 662-668
    CrossrefPubMedGoogle Scholar
  • 37 Wang D, Hou K, Zeng N. M-shaped auricular cartilage as modified septal extension graft: a study by three-dimensional anthropometric analysis in Asian rhinoplasty. Aesthetic Plast Surg 2021; 45 (05) 2287-2294
    CrossrefPubMedGoogle Scholar
  • 38 Zhang C, Jin TT, Li JY. et al. Application of conchal cartilage grafts in nasal tip plasty: comparison and experience of 3 methods. Ann Plast Surg 2021; 86 (3S, suppl 2): S199-S207
    CrossrefPubMedGoogle Scholar
  • 39 Haack S, Gubisch W. Reconstruction of the septum with an autogenous double-layered conchal L-strut. Aesthetic Plast Surg 2014; 38 (05) 912-922
    CrossrefPubMedGoogle Scholar
  • 40 Suh YC, Jeong WS, Choi JW. Septum-based nasal tip plasty: a comparative study between septal extension graft and double-layered conchal cartilage extension graft. Plast Reconstr Surg 2018; 141 (01) 49-56
    CrossrefPubMedGoogle Scholar
  • 41 Namgoong S, Kim S, Kim HR, Jeong SH, Han SK, Dhong ES. Folded cymba concha: is it large and stable enough for caudal septal extension graft in Asian rhinoplasty?. Aesthet Surg J 2021; 41 (07) NP737-NP747
    CrossrefPubMedGoogle Scholar
  • 42 Novoa E, Simmen D, Briner HR, Schlegel C. Long-term results after restoring nasal tip support using auricular cartilage as an intercrural columellar strut graft: the “I-Beam” technique. Rhinology 2018; 56 (02) 183-188
    CrossrefPubMedGoogle Scholar
  • 43 Sahin MS, Kasapoglu F, Demir UL, Ozmen OA, Coskun H, Basut O. Comparison of clinical results in nasal tip augmentation either via face to face or back to back technique with autogenous auricular conchal cartilage. J Craniofac Surg 2015; 26 (07) 2109-2114
    CrossrefPubMedGoogle Scholar
  • 44 Jackson O, Wingate N, Lee A, Kaye AE. The conchal butterfly graft in secondary reconstruction of the bilateral cleft lip nasal deformity. Int J Pediatr Otorhinolaryngol 2020; 129: 109737
    CrossrefPubMedGoogle Scholar
  • 45 Riedler KL, Shokrani A, Markarian A, Fisher LM, Pepper JP. Age-related histologic and biochemical changes in auricular and septal cartilage. Laryngoscope 2017; 127 (11) E399-E407
    CrossrefPubMedGoogle Scholar