Auricular Cartilage in Revision Rhinoplasty

Revision rhinoplasty has stimulated a variety of reconstructive techniques by surgeons dedicated to restoration of both nasal form and nasal function). Often, patients seeking revision or reconstructive rhinoplasty have previously undergone septoplasty with sacrifice of major amounts of septal cartilage. These situations confront the surgeon with the need for a decision about the material that will be used for structural grafting.

Implant materials may be categorized as autogenous tissue (cartilage, bone, fascia, and dermis), homo­graft materials (preserved, irradiated cartilage or bone, preserved acellular dermis or Alloderm, and others), and alloplastic materials. The senior author follows the time tested approach of generations of surgeons who have used exclusively autogenous material for nasal reconstruction because of its superior long-term survival characteristics, its ready availability in the head and neck region, its resistance to infection and resorption, and its bendability and flexibility when implanted in the nose).

The medical literature contains multiple reports that favor alloplasts for grafting. Although many alloplastic materials have emerged in the last 100 years, each has enjoyed only momentary success and then faded away as long-term difficulties with infection, extrusion, patient unacceptance, and other preventable complications became evident with time.

Gore Tex is the most recent alloplast championed in the literaturc. Godin et al. reported on 162 patients who received Gore-Tex implants during primary rhinoplasty and 147 patients who received Gore Tex implants for revision rhinoplasty. With an average of years follow-up, 2 of the 162 primary rhinoplasty patients (1.2%) had infections requiring removal of the Gore-Tex implants, and 8 of the 147 revision patients (5.4%) had infections requiring removal of the Gore-Tex.

Figure 1 (A) This patient had a rhinoplasty elsewhere and had a pollybeak deformity. She had overresection of the upper third of her nose and underresection of the middle vault. (B) Using conservation principles, the cartilaginous pollybeak was excised but not discarded. This precious tissue was placed into a precise pocket in the upper portion to balance the nose. Therefore, no other carti­lage grafting was required.

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