AURICULAR CARTILAGE HARVEST

The majority of our grafts for revision rhinoplasty are harvested from the external ear. As long as the antihelical fold is not transgressed, no significant change results in the appearance of the ear, even by the removal of the entire concha cavum and concha cymba. Segments of 3.5 to 4 cm are commonly available. In most patients, the cartilage is stiff yet pliable. Warping rarely, if ever, occurs.

Harvest of this cartilage may be undertaken by a pre- or postauricular approach. In the pre-auricular ap­proach, an incision is made just inside the antihelical fold and is therefore hidden by a shadow. Although we prefer the posterior approach, others prefer the anterior approach.

If the patient has one ear that protrudes more than the other, then the cartilage should be harvested from that side. If the patient sleeps on one side of the head, then the cartilage should be removed from the contralateral side.

Using 1% xylocaine solution with 1:100,000 epi­nephrine, the surgeon "hydrodissects" the skin of the concha cavum and cymba from the underlying cartilage. Subperichondreal injection of local anesthetic on the anterior surface of the conchal bowl facilitates dissection of the skin off the cartilage. The posterior surface is also injected with local anesthesia.

To proceed with the anterior approach, the sur­ geon may outline with a marking pen an incision that follows the outer edge of the cavum and cymba concha. This incision should be placed along the portion of the concha that is vertically oriented in relation to the lateral aspect of the skull. Then, the incision is made with a #15 blade, and the surgeon elevates the skin and perichondrium from the underlying cartilage. Dissection proceeds using ap­propriate scissors and also bluntly with cotton-tip applicators. Care is taken not to damage the soft auricular cartilage, which can tear. The dissection stops short of the cartilage of the external auditory canal.

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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.