Auricular Cartilage in Revision Rhinoplasty

The radix helices should be preserved. If the entire conchal bowl in excised, the auricle usually settles slightly closer to the head.

Figure 4 In the postauricular approach, an incision is made postauricularly in the skin overlying the eminentia of the concha. The skin-soft tissue envelope is elevated over the eminetia and the cartilage is incised, being careful to preserve an adequate amount of cartilage along the antihelical fold. The anterior skin and soft tissue are elevated in the subperichondrial plane and the cartilage is excised.

The surgeon dissects out the desired piece of car­tilage and leaves the underlying muscle behind (perichondrium remains adherent to the posterior surface of the cartilage). Avoiding deep dissection into the soft tissue minimizes bleeding.

After perfect hemostasis is achieved and the wound has been irrigated, the incision is closed. Commonly a 6-0 nylon running vertical mattress suture is used, although one may also close the incision with in­terrupted vertical mattress sutures. Special care is taken to avoid overlap of the skin edges. A bolster dressing of Telfa, dental roll, or other suitable material is placed into the concha and sutured into position to decrease the risk of hematoma. No residual deformity of the pinna is expected with this approach. In the postauricular approach, an incision is made postauricularly in the skin overlying the eminentia of the concha. The skin-soft tissue envelope is elevated over the eminetia, and the cartilage is incised, being careful to preserve an adequate amount of cartilage along the antihelical fold. The anterior skin and soft tissue are elevated in the subperichondrial plane and the cartilage is excised.

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