Auricular Cartilage in Revision Rhinoplasty

When undertaking revision or reconstructive rhi­noplasty requiring aesthetic and structural grafting, we always look first to the septum for additional residual cartilage. At times ample septal cartilage can be found despite a history of a prior septoplasty. Also, all other cartilaginous and bone sources in the nose are sought after and used when possible (Figs. 1, 2).

The subject of this article is the use of auricular cartilage in revision rhinoplasty. Careful strategic plan­ning must be undertaken to obtain the maximal and ideal benefit from the auricular cartilage. The revision rhi­noplasty surgeon must understand the anatomy of the external ear and must be able to manage the precious cartilage supply to get the maximum use of it in recon­structive rhinoplasty.

AURICULAR CARTILAGE ANATOMY
The revision rhinoplasty surgeon must be familiar with the anatomy of the external ear (Fig. 3). Among im­portant surface features is the helix, the prominent rim of the auricle. Parallel and anterior to the helix is an-other prominence known as the antihelix or antihelical fold. Superiorly, the antihelix divides into a superior and inferior crus, which surround the fossa triangularis. The depression between the helix and antihelix is known as the scapha or scaphoid fossa. The antihelical fold sur­rounds the concha, a deep cavity posterior to the exter­nal auditory meatus. The crus helicis, which represents the beginning of the helix, divides the concha into a su­perior portion, the cymba conchae, and an inferior por­ tion, the cavum conchae. The cavity formed by the concha on the anterior (lateral) surface of the ear corresponds to a bulge or convexity on the posterior (medial) surface of the ear that is known as the eminentia of the concha.

Anterior to the concha and partially covering the external auditory meatus is the tragus. The antitragus is posteroinferior to the tragus and is separated from it by the intertragic notch. Below the antitragus is the lobule that is composed of areolar tissue and fat.

Except for the lobule, the auricle is supported by thin, flexible elastic fibrocartilage. This cartilaginous framework is 0.5 to 1.0 mm thick and covered by a min­imum of subcutaneous tissue. 1 - 12 The skin is loosely adherent to the posterior surface and helix of the auric­ular cartilage. The close approximation of the skin to the anterior surface of the cartilage provides the auricle with its unique topographic features.

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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.