Download PDF
Facial Plast Surg 2021; 37(01): 092-097
DOI: 10.1055/s-0041-1722957
Original Article

Reconstruction of a Severely Damaged Cartilaginous Septum with a Bypass L-Strut Graft using Costal Cartilage

Woo Ri Choi
1   Department of Otorhinolaryngology—Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Changwon Hospital, Seoul, Republic of Korea
,
Yong Ju Jang
2   Department of Otorhinolaryngology—Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
› Author Affiliations Funding None.
› Further Information
Also available at
    Permissions and Reprints

Abstract

Objective Reconstruction of a weakened septal cartilage is a key procedure for the correction of deformed noses. However, when septal mucoperichondrium dissection is technically challenging, reconstruction of the lower two-thirds of the nose should be performed bypassing the damaged septal cartilage and mucosa. This article summarizes our experience with treating patients with severely damaged septal cartilage with bypass L-strut graft using costal cartilage.

Methods We retrospectively reviewed 26 patients who underwent rhinoplasty using bypass L-strut graft. Autologous costal cartilage was used for creating L-strut in two different ways: (1) by fashioning the L-shaped graft as one unit using the sixth rib cartilage and (2) by integrating a dorsal strut with a columellar strut using slices of the seventh rib cartilage. The caudal strut is fixated to the anterior nasal spine; the dorsal L-strut is placed on the nasal dorsum with no fixation to the nasal bone. Medical records were assessed for demographic, clinical, and treatment information.

Results One-piece-type L-strut graft was used for 11 patients and integrated-type L-strut graft was used for 15 patients. No statistical differences were found in postoperative aesthetic outcomes between the two groups. The postoperative assessment of surgical outcomes was excellent in 10 patients, good in 10, fair in 6, and poor in none. Functionally, all 26 patients experienced improvements in nasal breathing.

Conclusion Bypass L-strut graft using costal cartilage is a useful surgical maneuver of septal reconstruction in particular nasal deformity when the creation of the septal mucoperichondrial pocket is difficult or better to be avoided.

Keywords

augmentation rhinoplasty - L-shaped implants - costal cartilage grafts - septal cartilage damage - nasal deformity


Publication History

Article published online:
08 February 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Kim DW, Attenello NH. Reconstruction of the nasoseptal L-strut in rhinoplasty. JAMA Facial Plast Surg 2015; 17 (06) 457-458
    CrossrefPubMedGoogle Scholar
  • 2 Lan MY, Jang YJ. Revision rhinoplasty for short noses in the Asian population. JAMA Facial Plast Surg 2015; 17 (05) 325-332
    CrossrefPubMedGoogle Scholar
  • 3 Downs BW, Sauder HM. Septal Perforation. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2020
    Google Scholar
  • 4 Basaran K, Basat SO, Ozel A. et al. The effects of mucoperichondrial flap elevation on septal L-strut cartilage: a biomechanical and histologic analysis in a rabbit model. Plast Reconstr Surg 2016; 137 (06) 1784-1791
    CrossrefPubMedGoogle Scholar
  • 5 Shubailat GF. Cantilever rib grafting in salvage rhinoplasty. Aesthetic Plast Surg 2003; 27 (04) 281-285
    CrossrefPubMedGoogle Scholar
  • 6 Fomon S, Bell JW, Lubart J, Schattner A, Syracuse VR. Saddle nose and the L-shaped graft. AMA Arch Otolaryngol 1960; 71: 932-937
    CrossrefPubMedGoogle Scholar
  • 7 Qian SY, Malata CM. Avoiding pitfalls in open augmentation rhinoplasty with autologous L-shaped costal cartilage strut grafts for saddle nose collapse due to autoimmune disease: the Cambridge experience. J Plast Reconstr Aesthet Surg 2014; 67 (08) e195-e203
    CrossrefPubMedGoogle Scholar
  • 8 Shipchandler TZ, Chung BJ, Alam DS. Saddle nose deformity reconstruction with a split calvarial bone L-shaped strut. Arch Facial Plast Surg 2008; 10 (05) 305-311
    CrossrefPubMedGoogle Scholar
  • 9 Lee HJ, Jang YJ. Correction of saddle and short noses. Curr Opin Otolaryngol Head Neck Surg 2016; 24 (04) 294-299
    CrossrefPubMedGoogle Scholar
  • 10 Riechelmann H, Rettinger G. Three-step reconstruction of complex saddle nose deformities. Arch Otolaryngol Head Neck Surg 2004; 130 (03) 334-338
    CrossrefPubMedGoogle Scholar
  • 11 Gunter JP, Cochran CS, Marin VP. Dorsal augmentation with autogenous rib cartilage. Semin Plast Surg 2008; 22 (02) 74-89
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Karimi E, Mehdizadeh J, Bastaninejad S, Koohkan M. Integrated internal stabilization for saddle nose surgery. Iran J Otorhinolaryngol 2016; 28 (85) 121-124
    PubMedGoogle Scholar
  • 13 Leach L, Shamil E, Malata CM. Indications and long-term outcomes of open augmentation rhinoplasty with autogenous L-shaped costal cartilage strut grafts - a single plastic surgeon's experience. Otolaryngol Pol 2018; 72 (03) 26-32
    CrossrefPubMedGoogle Scholar
  • 14 Yeo NK, Jang YJ. Rhinoplasty to correct nasal deformities in postseptoplasty patients. Am J Rhinol Allergy 2009; 23 (05) 540-545
    CrossrefPubMedGoogle Scholar
  • 15 Cakmak O, Bircan S, Buyuklu F, Tuncer I, Dal T, Ozluoglu LN. Viability of crushed and diced cartilage grafts: a study in rabbits. Arch Facial Plast Surg 2005; 7 (01) 21-26
    CrossrefPubMedGoogle Scholar
  • 16 Kayabasoglu G, Ozbek E, Yanar S. et al. The comparison of the viability of crushed, morselized and diced cartilage grafts: a confocal microscopic study. Eur Arch Otorhinolaryngol 2015; 272 (05) 1135-1142
    CrossrefPubMedGoogle Scholar
  • 17 Taştan E, Yücel OT, Aydin E, Aydoğan F, Beriat K, Ulusoy MG. The oblique split method: a novel technique for carving costal cartilage grafts. JAMA Facial Plast Surg 2013; 15 (03) 198-203
    CrossrefPubMedGoogle Scholar