Subtotal Reconstruction of the Nasal Septum Using a Conchal Reshaped Graft

Abstract

The caudalmost section of the cartilaginous nasal septum performs the important function of supporting the middle and lower third of the nose. Its absence leads inevitably to deformation of the nasal pyramid and collapse of the internal nasal valve. The most frequent causes of its loss are iatrogenic and traumatic, and the mucoperichondrial lining remains intact in most cases. A graft of conchal cartilage constitutes the preferred method of reconstruction due to the capacity of the transplanted tissue to acquire characteristics of shape, elasticity, and strength closely resembling those of the original tissue to be replaced. The auricular concha differs in anatomic shape from the nasal septum and tends, when deformed, to return to its initial appearance due to cartilaginous memory. The auricular cartilage is also less robust than the quadrangular. The paper describes a surgical technique for reshaping of the conchal cartilage that makes it possible to obtain a practically straight conchal graft that will retain its stability over time with no risk of subsequent modification. The technique involves a double figure-of-8 suture together with incisions on the concave side of the graft for straightening purposes. The simultaneous use of 2 spreader grafts taken from and attached to the concha itself helps to maintain straightness and reinforce the structure. The graft is then placed in position via open access and secured between the 2 mucoperichondrial flaps after these have been carefully detached. The tissue and technique used make it possible to restore the original condition in anatomic and physiological terms, eliminating the esthetic impairment and regaining respiratory functionality.

Surgical techniques for the treatment of nasal valve collapse

“…Active anterior rhinomanometry is used to determine airway resistance and produces a characteristic curve during nasal valve collapse as demonstrated in Figure 2. Five authors8, 9, 22, 23, 38 present reductions in airway resistance in 83% to 100% of patients.…”

“…The surgical techniques described addressed collapse of the INV or ENV or both. The studies were grouped on this basis and are presented in Tables I, II, and III 7–48. The lack of any high‐quality studies precludes the pooling of data and thus meta‐analysis is neither possible nor appropriate.…”

“…Since then much use has been made of this technique, and many authors have described variations on the theme. Ziljker,7 Constantian,9 Park10 Scutio,11 Stal,13 Andre,19 Khosh,20 Boccieri22, 23 Faris,25 Most,26 Arslan,27 and Schlosser40 all report results using Sheen's spreader graft with a number of modifications. Endonasal placement is described by Andre,19 and may have advantages (less invasive and may be easily combined with other functional procedures such as septoplasty and ethmoidectomy); however, no study comparing the two approaches was identified.…”

25 Nasal Valves: Importance and Surgical Procedures

“…A straight septum is important for unimpaired nasal valve function, 11 and if material is missing, replacement is required. 12 In any case, the goal is creating bilateral symmetrical cross sections in the nasal valve area. According to Pirila and Tikanto, 13 the subjective sensation of nasal obstruction is decreased significantly by increase of cross-sectional area on the side of the deviation, although on the opposite side the cross-sectional area is reduced and the bilateral parameters of acoustic rhinometry and rhinomanometry show only a slight increase or none.…”

A biomechanical study regarding the effect of tissue harvesting from the thorax on its movement during inspiration

“…In the practice of plastic surgery, transplantation of auto-grafts -such tissues as auricular cartilage [1][2][3][4][5][6], nasal septum cartilage [7], and iliac bone [8] -is often conducted. Besides these tissues, ribs and costal cartilages are also harvested and used for augmentation of the nose [9] or reconstruction of the ear [10][11][12][13][14][15][16] or skull.…”