Folded Cymba Concha: Is It Large and Stable Enough for Caudal Septal Extension Graft in Asian Rhinoplasty?

Abstract

Background Septal extension grafting (SEG) is used for nasal tip projection and positioning. Often, insufficient quadrangular cartilage is available for grafting in Asians and in most secondary cases, the septum is already harvested. We utilized the folded cymba concha as an alternative for caudal SEG (CSEG) by modifying a tongue-in-groove technique. Objectives To evaluate the physical validity of the cymba concha for CSEG and compare its outcomes with those of septal quadrangular cartilage. Methods The mean length and width of 311 harvested consecutive folded cymba conchae were measured from intraoperative photographs. Data from 220 patients with >12 months of follow-up were retrospectively reviewed for clinical outcomes. Clinical demography was determined based on the need for additional spreader grafts. For clinical reliability, anthropometric photographs of patients in whom folded cymba conchae were used were compared with those in whom quadrangular cartilage was used. Results Mean lengths and widths of the folded cymba conchae in men and women were 24.2 ± 3.9 and 22.4 ± 3.7 mm, and 7.8 ± 1.9 and 7.2 ± 1.9 mm, respectively. Using the folded cymba concha graft significantly increased nasal tip projection by 28.9% and columellar-labial angle by 9.7%, improving both aspects postoperatively. Anthropometric comparison revealed no significant differences between folded cymba conchae and septal cartilage in terms of nasal tip projection (p = 0.264) and postoperative columellar-labial angle (p = 0.182). Conclusions Folded cymba conchal cartilage can be a primary option for CSEG in Asian septorhinoplasty cases or for individuals with insufficient septal cartilage remnants.

Hybrid columellar strut using nasal crest bone of the maxilla and conchal cartilage for nasal tip stability in rhinoplasty for East Asian patients

“…In accordance with the algorithm, the columellar strut and medial crural suture play key roles in providing a stable and sturdy nasal base, especially in patients with thick-skinned noses [13]. Various autologous cartilage grafts, such as the doublelayered conchal cartilage septal extension graft, double-layered septal cartilage columellar strut graft, double-layered conchal cartilage columellar strut graft, comma-shaped costal cartilage columellar strut graft, and L-shaped septal cartilage columellar strut graft, have been introduced for nasal tip plasty, but no consensus exists regarding the optimal method [3,5,6,9].…”

“…Moreover, according to Rohrich's recent paper [14], a single columellar strut made of ear cartilage is not appropriate for adequate tip projection and precise tip rotation control. Several studies advocated the usefulness of the double-layered conchal cartilage columellar strut graft for nasal tip plasty [6,9]. However, postoperative changes, including a tendency for cephalic rotation of the nasal tip, were also reported in these studies [6,9].…”

“…Several studies advocated the usefulness of the double-layered conchal cartilage columellar strut graft for nasal tip plasty [6,9]. However, postoperative changes, including a tendency for cephalic rotation of the nasal tip, were also reported in these studies [6,9].…”

“…From the standpoint of visible scars, the posterior approach for ear cartilage harvest is superior. However, the neurovascular system is distributed along the posterior surface of the ear, and it can be damaged when the posterior approach is performed [9]. We used an anterior approach with precise dissection of conchal cartilage and preservation of the perichondrium of the anterior skin flap.…”

“…However, delayed extrusion often occurs at the nasal tip when an L-shaped alloplastic implant is applied on the columellar strut because of excessive skin tension and pressure necrosis [8]. Several types of grafts using autologous cartilage, such as the double-layered conchal cartilage septal extension graft, double-layered septal cartilage columellar strut graft, double-layered conchal cartilage columellar strut graft, comma-shaped costal cartilage columellar strut graft, and L-shaped septal cartilage columellar strut graft have been introduced recently, but no consensus exists regarding the optimal method [3,5,6,9]. Furthermore, each extant autologous cartilage graft has drawbacks associated with its intrinsic strength, tendency of warping, and morbidity after the harvesting procedure.…”