Correction of the Short Nose Using Ear Cartilage Graft

Purpose: Short nose deformity is caused by various reasons and difficult to correct and reach the constant optimal outcomes. It is imperative to reposition the alar cartilage caudally with proper fixation in short nose correction. Among several techniques to maintain the lengthened cartilagenous tip structure, septal extension graft with septal cartilage or rib cartilage is most widely used.(1-3) But in many cases, nasal tip rigidity with unnatural appearance on smiling is one of the major drawbacks of septal extension graft. To avoid these shortcomings, the authors used a piece of elastic cartilage graft harvested form ear that can act as a cushion buffer between alar cartilage and septum instead of directly fixing the alar cartilage to extended septum for obtaining a less stiff nasal tip with sufficient nasal tip elongation. We called this graft "derotation graft".

Methods: To obtain the proper caudal rotation of the nasal tip, the lower lateral cartilages were released from caudal border of the upper lateral cartilages. The columellar strut was fixed between the medial crus for tip projection. A piece of elliptical shaped derotation graft harvested form concha was fixed between the alar cartilage and caudal dorsal septum to maintain the tip at a new caudal position and play a role of cushion buffer avoiding tip stiffness.

Experience: From April 2002 to March 2011, derotation graft was performed in 1197 patients via the open nasal approach. Among them, 432(36%) patients had preoperative short nose deformity and 765(64%) patients developed intraoperative cephalic rotation of the tip resulting from procedures for tip projection such as columellar strut.

Results: The duration of follow-up ranged from 1 month to 10 years, with an average of 12.2 months. Excellent results were achieved in 1110(93%) patients. 87(7%) patients had unsatisfactory results requiring a revision surgery because of overcorrection or undercorrection of tip rotation, poor tip projection and visible graft on supratip.

Conclusions: Derotation graft is a simple, effective procedure for short nose correction and prevention with less post-operative nasal tip rigidity.