AURICULAR CARTILAGE

In some cases of severe dorsal collapse, structural auricular cartilage is not appropriate, and rib graft or cranial bone graft for an intercalated L-strut reconstruc­tion is necessary. Irradiated rib grafts have also been described for this use.

Alar batten grafts are commonly needed in revision rhinoplasty. 20 This is due to the unfortunately too frequent problem of overresection of the lateral crus, resulting in weakness of the lateral nasal sidewall with re-traction, especially on inspiratory effort. Auricular cartilage is especially well suited to alar batten grafting due to the slight curvature of its contour. Alar batten grafts are designed to stiffen and hold the flaccid ala laterally and are well described in the literature. The graft is positioned in the supraperichondrial plane but in a non-anatomic position along the nostril rim extending to the pyriform aperture (Fig. 9). In more severe cases of alar retraction, composite grafts of auricular cartilage and skin may be required.

At times, alloplastic implants must be removed when they extrude through the skin, cause pain, or extrude through the nose. In these cases, these grafts can be replaced by auricular cartilage (Fig. 10).

DISCUSSION
Although revision rhinoplasty can often be accomplished in a simple, direct fashion with minimal need for complicated reconstructive grafting, at times the patient's problems require more complex surgery with significant structural and reconstructive grafts. Unfortunately, the ideal nasal implant, natural or artificial, does not yet exist, and so the reconstructive surgeon must select a material that fulfills the needs with the most minimal morbidity. We feel that the cartilage autograft fulfills these criteria better than any other currently available material. We have found, as have others previously, that cartilaginous autografts can be used to correct a wide variety of nasal defects with gratifying results and without major complication. Until an ideal implant is identified, cartilage autografts remain our nasal reconstructive material of choice.

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Ask Dr. Becker a question about corrective nose surgery or arrange an appointment for a nose surgery consultation by calling 856-589-NOSE (6673) or emailing us at info@revisionrhinoplasty.com.