Bone grafts as a recyclable material in nasal surgeries

Indications, Stability, and Surgical Outcomes of Using Osteochondral Nasal Septal Graft as a Septal Extension Graft in Rhinoplasty Patients: A Prospective Cohort Study

Septal extension graft (SEG) is an adaptable tool that controls, supports, and stabilizes the nasal tip projection, rotation, length, and shape. Recent studies comparing SEGs to more conventional columellar strut grafts found that SEGs provided improved results. This prospective cohort study included 66 patients divided into 2 groups based on their indications. Group 1 was patients who underwent septorhinoplasty using osteochondral septal extension graft (OSEG), and group 2 underwent septorhinoplasty using cartilaginous SEG. The main reason for undergoing OSEG was insufficient septal cartilage (P<0.001). The outcomes were not significantly different between both groups, with the % of patients who experienced positive outcomes ranging from 78.8% to 97%. The OSEG is a safe, valid, and effective option in septorhinoplasty that can be used in patients with insufficient cartilaginous septum.

Outcome Evaluation of Using Bone-Cartilaginous Units to Correct Deviated Noses in Rhinoplasty

Background: Aesthetic and functional problems related to a deviated nose are challenging to correct with rhinoplasty. Objective: To compare the outcome of rhinoplasty using nasal septal bone-cartilaginous units (BCUs) as measured by pre- and postoperative patient-reported outcomes and photograph analysis. Methods: A retrospective chart review was conducted on rhinoplasty patients who had BCU placed between February 2018 and March 2021. Three-dimensional photographic measurements were assessed before and at least 1 year after surgery using Mirror software. Data on patient satisfaction were collected by the Nasal Obstruction Symptom Evaluation (NOSE) and the Rhinoplasty Outcomes Evaluation (ROE) questionnaires. Statistical analysis was completed with independent t-tests and Wilcoxon signed-rank test. Results: Twenty-eight patients were enrolled with a mean age of 34.52 ± 13.7 years (range 20-77 years) and mostly female (61%). The degree of nasal deviation (from 1/82° ± 1/52° to 0/13° ± 0/45°) and the width of the middle nasal third to palpebral fissure length (from 1/28° ± 0/18° to 1/19° ± 0/19°) significantly changed (p-value <0.001). NOSE and ROE scores also improved significantly postoperation (p-value <0.001). Conclusion: The bone-cartilaginous unit graft was effective in rhinoplasty for nasal deviations and may be considered an option.

Bony Cartilaginous Graft in Unilateral Cleft Lip Rhinoplasty

BACKGROUND

Cleft rhinoplasty is a challenging form of nasal correction of both esthetic and functional deformities. The septal cartilage in many Asian patients are not sufficient and weak. Does a combination of the septal cartilage and the bony septum have both esthetic and functional benefits to secondary unilateral cleft rhinoplasty?

PATIENTS AND METHODS

Thirty patients with a unilateral cleft lip palate underwent open rhinoplasty from October 2018 to January 2021. After preserving a 10 mm L-strut, the posterior cartilaginous and bony septum were harvested as an integrative unit. The osteocartilaginous graft was used as a caudal septal extension graft and an extended spreader graft. Correcting the asymmetry of the tip and tip projection followed. The intraoperative harvested composite graft was analyzed. Acoustic rhinometry and the 3-dimensional anthropometric measurements of the external nose were assessed before and after surgery.

RESULTS

The osteocartilaginous unit was much larger than the cartilaginous part of this unit. The mean nasal tip height and the nasolabial angle increased significantly after surgery. The measurement of cross-sectional areas and volumes by acoustic rhinometry revealed that septorhinoplasty provided a significant increase in the function of both nasal cavities.

CONCLUSIONS

This septal bony cartilaginous graft is effective for cleft lip nasal deformity when correcting the deviated septum, creating a supporting frame to correct the nasal tip asymmetry, improving function.

Analysis of Factors Affecting Postoperative Drainage After Comprehensive Rhinoplasty

This study aimed to explore and analyze the factors influencing the drainage volume after comprehensive rhinoplasty. The clinical data of 102 patients who underwent comprehensive rhinoplasty at Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine from August 2019 to August 2021 were retrospectively analyzed. The effects of age, sex, body mass index, whether an osteotomy was performed, and whether a nasal septum flap was obtained on the indwelling time of the drainage tube after the operation were analyzed by single factor analysis and multiple logistic regression analysis. Age, body mass index, whether it was a primary rhinoplasty, whether an osteotomy was performed, and whether a nasal septum flap was obtained were the influencing factors for drainage time after augmentation rhinoplasty ( P <0.05). Sex had little effect on the drainage time after comprehensive rhinoplasty ( P >0.05). Body mass index, whether an osteotomy was performed and whether a nasal septum flap was obtained were the independent influencing factors for the postoperative drainage time ( P <0.05). For patients with multiple independent influencing factors, individualized management during the perioperative period should be promoted, and reasonable treatment strategies should be formulated, so as to reduce the indwelling time of the drainage tube after the operation.

Surgical Outcomes of Bony Batten Grafting Through Endonasal Septoplasty in the Correction of Caudal Septum Deviation

OBJECTIVE

The aim of the present study was to evaluate the efficiency and usefulness of bony batten grafts through endonasal septoplasty in the correction of caudal septum deviations.

METHOD

In this case-controlled retrospective study, 65 patients who had bony batten graft procedure for the correction of caudal septum deviation using endonasal septoplasty with complete pre-operative and post-operative questionnaire information and complete post-operative follow-up data (an average follow-up period of 24.1 months) in our hospital in September 2013 and August 2018 period were evaluated. Nasal Obstruction Symptoms Evaluation (NOSE) scores of the patients before and after the operation were compared. Besides, severity of nasal symptoms (mouth dryness, hyposmia, rhinorrhea, epistaxis and snoring) before and after the operation was compared using visual analog scale (VAS). Complications which developed in post-operative period were also analyzed.

FINDINGS

Average age of the 65 patients (14 female and 51 male) was 27.6 ± 11.3. A straight septum was achieved in 57 patients (87.6%) in post-operative period while 8 patients (12.4%) had residual deviation. Average pre-operative NOSE score was 79.8 ± 22.3 while average post-operative NOSE score was 21.4 ± 4.6 and the difference was significant (P < 0.0001). Significant improvements were observed in VAS scores of all evaluated symptoms in post-operative period. Two patients developed septal hematoma in post-operative period.

CONCLUSION

Bony batten graft procedure through endonasal septoplasty is an efficient and useful method with low complication rate for the correction of deviation of caudal septum.

Short Nose Correction: Septal Cartilage Combined With Ethmoid Bone Graft

BACKGROUND

Multiple methods are employed to correct short nose deformities, with septal extension graft representing the first choice for Asians. However, the volume of the septal cartilage in many Asian patients is not sufficient to be used alone for such operation. The present work developed a new method combining the septal cartilage with ethmoid bone graft to overcome this issue in Asian patients with short noses.

METHODS

Thirty-five women with short noses underwent septal extension graft from February 2015 to March 2017. The endoscopic technique was utilized to harvest the ethmoid bone to enhance the L-strut structure. An L-strut, comprising 0.8 cm segments of the caudal and dorsal cartilaginous septa, is left altered in order to harvest more cartilage for septal extension. The harvested the septal cartilage, approximately 1.0 mm thick and 16 to 20 mm long, underwent grafting on one side of the caudal septum. This was followed by alar cartilage fixation at the septal cartilage graft end. Finally, nose length, nasal tip projection and nasolabial angle were assessed before and after the surgery.

RESULTS

Septal cartilage combined with ethmoid bone graft yielded an adequate nose lengthening and reduced nostril show, also in individuals showing extremely little septal cartilage.

CONCLUSIONS

This new method is effective for short nose deformity correction in Asian patients. Combining the septal cartilage with ethmoid bone graft yields ideal outcome without overt complications, achieving commendable patient satisfaction.

Anatomical Characteristics of the Perpendicular Plate of the Ethmoid: An Analysis of Paranasal Sinus Computed Tomography via Three-Dimensional Reconstruction

In recent years, the perpendicular plate of the ethmoid (PPE) has emerged as a new autogenous grafting material in rhinoplasty and septoplasty of nasal deviation. However, no studies have outlined the precise size, shape, and morphologic features of the PPE. Therefore, this study aimed to provide detailed information on the anatomical and morphologic characteristics of the PPE to assist surgeons in performing surgeries that are more precise. About 104 Chinese patients who underwent paranasal computed tomography were assessed in this study. By analyzing the features of the PPE reconstructed with 3-dimensional models, the characteristics of the PPE at different stages of development and according to sex were observed. The PPE had a flat shape, and its lower part was relatively thin. It usually developed horizontally with age, which contributed to expansion of the PPE area. The dimensions of the PPE were significantly larger in male patients than in female patients. Through the reconstruction and measurement of Chinese patients' PPE, the authors have established precise information about the PPE's anatomical and morphologic features. The flat shape and proper size, which are similar to those of nasal septum cartilage, make the PPE an ideal alternative to conventional autogenous grafting materials. The findings might be useful to surgeons in helping them perform surgeries that are more precise.

Use of Bone-Cartilaginous Unit in Revision Rhinoplasty

BACKGROUND

Insufficient septal cartilage is a common finding when performing revision rhinoplasty. Such cases require costal or conchal cartilage to be harvested, which is time consuming and brings the risk of morbidity. A new technique involves the use of a septal bone-cartilage composite graft or a bone-cartilaginous (BC) unit as a rhinoplasty graft.

OBJECTIVES

The aim of this research was to evaluate the subjective and objective effects of using a BC unit graft in revision rhinoplasty.

METHODS

In this clinical trial, we examined 40 patients with insufficient septal cartilage for grafting who were referred to a tertiary center and a private setting from January 2016 to March 2017 for revision septorhinoplasty. The patients had nasal deformity and nasal obstruction. Assessment of surgical outcome was based on anthropometric measurements and by measuring the width of the middle nasal third from photographs, and on 2 patient questionnaires: the Nasal Obstruction and Septoplasty Effectiveness (NOSE) and the Rhinoplasty Outcome Evaluation (ROE) questionnaires.

RESULTS

Nasolabial angles and the middle nasal third improved significantly after surgery (P < 0.005). Based on the NOSE questionnaire, 85% of patients had no or mild nasal obstruction, and the ROE questionnaire indicated that 62.5% were completely or very satisfied with the appearance of their nose.

CONCLUSIONS

The BC unit is an effective graft in revision rhinoplasty, and can be used in place of the rib graft. In skilled hands, harvesting of this graft results in no morbidity and is not time consuming.

LEVEL OF EVIDENCE: 4

The bony cartilaginous unit: the missing graft in septorhinoplasty

To achieve the desired nasoseptal refinements in septorhinoplasty, sufficient septal cartilage is needed. There are many cases in which septal cartilage is insufficient, especially in revision surgery. To obtain an optimal outcome, a bony cartilaginous unit is proposed as a versatile graft for various parts of the nose. This bony cartilaginous unit is extracted using the open septorhinoplasty approach in which the bilateral septal flaps are elevated over the entire cartilaginous and bony part; however, the cartilaginous septum and posterior bony part are not separated and are removed as an integrated unit. These bony cartilaginous units can be used as various types of grafts at different sites in the nose. In the present study, the bony cartilaginous units were used as caudal extension grafts, spreader grafts, lateral crural strut grafts, and for the closure of septal perforations. This research has shown the advantage of using septal bone in conjunction with cartilage as an integrated unit to correct external nose and septal deformities, especially in cartilage-depleted patients.