The Role of Septal Cartilage in Rhinoplasty: Cadaveric Analysis and Assessment of Graft Selection

Pochat, Victor Diniz de; Alonso, Nivaldo; Figueredo, Adson Andrade de; Ribeiro, Emilie B.; Mendes, Rogério Rafael da Silva; Meneses, José Válber Lima

doi:10.1177/1090820x11424149

Cited by 27 publications

(21 citation statements)

References 22 publications

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“…They were cut into right-angled, L-shaped pieces, with the long limb measuring 30 mm and the short limb measuring 20 mm to correlate with previous investigations of nasal septal anatomy. 6 Widths of L-strut limbs were carved in a range of 5 to 20 mm. Yield strength in each L-strut was obtained in the same manner as cadaver cartilage, except that the L-struts were held at the distal end of the 2 limbs in the vise grip while the junction of the limbs was compressed.…”

Section: Septal Cartilage Modelmentioning

confidence: 99%

Yield Strength Testing in Human Cadaver Nasal Septal Cartilage and L-Strut Constructs

Liu

Messinger

Inman

2017

JAMA Facial Plast Surg

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IMPORTANCE To our knowledge, yield strength testing in human nasal septal cartilage has not been reported to date. An understanding of the basic mechanics of the nasal septum may help surgeons decide how much of an L-strut to preserve and how much grafting is needed. OBJECTIVES To determine the factors correlated with yield strength of the cartilaginous nasal septum and to explore the association between L-strut width and thickness in determining yield strength. DESIGN, SETTING, AND PARTICIPANTS In an anatomy laboratory, yield strength of rectangular pieces of fresh cadaver nasal septal cartilage was measured, and regression was performed to identify the factors correlated with yield strength. To measure yield strength in L-shaped models, 4 bonded paper L-struts models were constructed for every possible combination of the width and thickness, for a total of 240 models. Mathematical modeling using the resultant data with trend lines and surface fitting was performed to quantify the associations among L-strut width, thickness, and yield strength. The study dates were November 1, 2015, to April 1, 2016. MAIN OUTCOMES AND MEASURES The factors correlated with nasal cartilage yield strength and the associations among L-strut width, thickness, and yield strength in L-shaped models. RESULTS Among 95 cartilage pieces from 12 human cadavers (mean [SD] age, 67.7 [12.6] years) and 240 constructed L-strut models, L-strut thickness was the only factor correlated with nasal septal cartilage yield strength (coefficient for thickness, 5.54; 95% CI, 4.08-7.00; P < .001), with an adjusted R 2 correlation coefficient of 0.37. The mean (SD) yield strength R 2 varied with L-strut thickness exponentially (0.93 [0.06]) for set widths, and it varied with L-strut width linearly (0.82 [0.11]) or logarithmically (0.85 [0.17]) for set thicknesses. A 3-dimensional surface model of yield strength with L-strut width and thickness as variables was created using a 2-dimensional gaussian function (adjusted R 2 = 0.94). Estimated yield strengths were generated from the model to allow determination of the desired yield strength with different permutations of L-strut width and thickness. CONCLUSIONS AND RELEVANCE In this study of human cadaver nasal septal cartilage, L-strut thickness was significantly associated with yield strength. In a bonded paper L-strut model, L-strut thickness had a more important role in determining yield strength than L-strut width. Surgeons should consider the thickness of potential L-struts when determining the amount of cartilaginous septum to harvest and graft. LEVEL OF EVIDENCE NA.

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Section: Septal Cartilage Modelmentioning

confidence: 99%

Yield Strength Testing in Human Cadaver Nasal Septal Cartilage and L-Strut Constructs

Liu

Messinger

Inman

2017

JAMA Facial Plast Surg

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“…As prior research has shown, changing the anatomical constructs of L-struts affects its underlying strength as compared to the unaltered septa. 2,10,12,13 As such, the C-strut concept informs the surgeon, during creation of the cartilage cuts, to arc the incisions posteriorly in a curvilinear fashion, paralleling the natural caudal and dorsal arc to ensure adequate strut width and maximal cartilage harvest. For example, a surgeon working within the L-strut paradigm may adequately estimate the strut width from the ASP but continue a linear cartilage cut that does not adequately provide enough distance from the PCSP.…”

Section: Discussionmentioning

confidence: 99%

Redefining the nasal septal L‐strut: A quantitative analysis of septal arcs and angles

et al. 2018

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“…The thickest part was the septal base anterior to the vomer, which was approximately 2.19-3.03 mm in size, and the thinnest part, at 1.03-1.22 mm, was just above the septal base at 20% of the septal height. Meanwhile, de Pochat et al [10] stated that the average length and height of the septum of a Brazilian sample was 35.4 mm and 32.5 mm, respectively. The thickest part was 1.7 mm and the thinnest part, 1.04 mm.…”

Section: Importance Of Stabilitymentioning

confidence: 99%

Obtaining Maximal Stability with a Septal Extension Technique in East Asian Rhinoplasty

Jeong¹

2014

Arch Plast Surg

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Recently, in Korea, the septal extension graft from the septum or rib has become a common method of correcting a small or short nose. The success rate of this method has led to the blind faith that it provides superior tip projection and definition, and to the failure to notice its weaknesses. Even if there is a sufficient amount of cartilage, improper separation or fixation might waste the cartilage, resulting in an inefficient operation. Appropriate resection and effective fixation are essential factors for economical rhinoplasty. The septal extension graft is a remarkable procedure since it can control the nasal tip bidirectionally and three dimensionally. Nevertheless, it has a serious drawback since resection is responsible for septal weakness. Safe resection and firm reconstruction of the framework should be carried out. Operating on the basis of the principle of "safe harvest" and rebuilding the structures is important. Further, it is important to learn several techniques to manage septal weakness, insufficient cartilage quantity, and failure of the rigid frame during the surgery.

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The Role of Septal Cartilage in Rhinoplasty: Cadaveric Analysis and Assessment of Graft Selection

Abstract: Anatomical variations of the thickness of septal cartilage excisions were found to be statistically significant, and these differences play an important role in the proper selection of the septal grafts.

Cited by 27 publications

References 22 publications

Yield Strength Testing in Human Cadaver Nasal Septal Cartilage and L-Strut Constructs

Yield Strength Testing in Human Cadaver Nasal Septal Cartilage and L-Strut Constructs

Redefining the nasal septal L‐strut: A quantitative analysis of septal arcs and angles

Obtaining Maximal Stability with a Septal Extension Technique in East Asian Rhinoplasty

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