Dr.K.O.Paulose FRCS DLO, Consultant ENT Surgeon, Jubilee Hospital, Trivandrum, Kerala, India.
Augmentation Rhinoplasty
Rhinoplasty may require the addition of material to augment the nose. Augmentation is necessary for both aesthetic and functional indications. Functional reasons for augmentation include providing structural support for areas deficient of material, such as the upper or lower lateral cartilages. Augmentation may also be required for aesthetic reasons. Typically, augmentation rhinoplasty is performed to increase the projection of the nasal dorsum on the profile view. The nasal tip may also be augmented. In addition, grafts may be placed to camouflage irregularities of the bony dorsum and of the upper or lower lateral cartilages.
Many surgeons prefer to use autologous tissue whenever possible, and some evidence suggests a lower incidence of infection when the patient’s own tissue is used. Autologous materials have the potential to be incorporated into the host tissue bed, offering stability, as well as resistance to infection and extrusion over time.
Cartilage grafts-Septal, Conchal , Tragal cartilage
One of the advantages of septal cartilage is the ease of harvest from the surgical field. Septal cartilage tends to be well suited for augmentation rhinoplasty.
A relative disadvantage is that an adequate amount of septal cartilage is often not available for moderate-to-severe augmentation in patients who have undergone previous septorhinoplasty. This shortcoming is due to resection of septal cartilage at the time of previous surgery or the resorption of the residual septal cartilage over time.
Auricular cartilage is easily harvested and generally sufficient for mild-to-moderate augmentation. However, auricular cartilage has a tendency to warp or crack, with efforts to soften or crush the edges. This donor cartilage can also be difficult to use in persons who need a straight graft (eg, columellar strut). Conchal graft is taken by anterior approach, make sure the incision is just below the trim of concha cavum.Hydrodisectiion and meticulous elevation of the flaps give a good intact graft. If you need one can take graft from both side and use sandwhich technique.A bolster dressing is sutured in place to avoid haematoma.
Tragal cartilage
Easy to take and good for collumellar strut.No scars and easy access.
Procedure.
As shown in the video footage above-
Please make sure take the graft from not dominant ear –using phone or sleeping on same side.
