How to Overcome Troublesome Obstacle in Asian Short Nose: Hybrid Septal Extension Graft

Introduction

There are several obstacles in many steps of the correction process of Asian short noses, such as: releasing of alar cartilage, lengthening of dorsal skin flap, and harvesting of septal cartilage for septal extension.

Among these, the most common obstacle would be encountering a very small septal cartilage. Most Asian patients have very small and insufficient septal cartilage which makes it difficult to them for septal extension graft effectively. As an alternative to this, autogenous rib cartilage or irradiated homologous costal cartilage (IHCC) could be considered to be useful. However, these will lead to other negative results like scar on the chest and a very rigid tip of the nose.

Therefore, septal extension graft with a small septal cartilage combined with IHCC (hybrid septal extension graft) could be considered as a good solution in such situations.

Methods:

Carve the irradiated homologous costal cartilage into a shape of thin batten, and securely fix them to caudal septum bilaterally. In general, the caudal ends should not exceed the medial crus.

Controlling minimum level of crossing the membranous septum is recommended to ensure the softness and mobility of the columella and tip. Harvested septal cartilage should be located between the two IHCC batten grafts and fixed with sutures. Fix the alar cartilage at the end of septal cartilage graft. Ear cartilage could be used as an alternative to IHCC.

If the septal cartilage is exceptionally small (harvested septal cartilage is less than 1cm ) which makes it impossible to use conventional septal extension graft, septal cartilage can be pulled front and fixed with IHCC without touching the caudal septum.

Results:

Nasal lengthening with hybrid septal extension graft showed a positive result with enough lengthening and decreased nostril show, even in a case with very small septal cartilage. Nasal tip was much softer than the cases with septal extension graft with rib cartilage or IHCC only. When using ear cartilage instead of IHCC, this hybrid technique could give even more mobile tip.

Conclusions:

A very small septal cartilage, the most common obstacle of Asian short nose correction, can be overcome by hybrid septal extension graft. Even with a very small septal cartilage, tip lengthening could be done effectively and the tip will be much softer and mobile after the surgery, compare to the cases of using rib cartilage or IHCC only. This technique ensures the possibility of septal extension graft even in the situations with useless small septal cartilage. And another important advantage of this technique would be the softness of nasal tip from easy mobility.