A Mortise and Tenon Framework Composed of Costal Cartilage and Expanded Polytetrafluoroethylene in Rhinoplasty for Asians: Application Ⅱ of Dai Exogenous Extension Stent Concept

Abstract

Background: The septum is often underdeveloped in East Asian populations, and traditional endogenous extension stents may not adequately fulfill the requirements for rhinoplasty. Herein, we present an innovative exogenous extension framework featuring a mortise and tenon structure specifically designed for East Asians. Methods: This framework comprises a mushroom-shaped rib cartilage component and a lancet-shaped expanded polytetrafluoroethylene (ePTFE) element, which are interconnected through a mortise and tenon design. The costal cartilage serves as a strut to support the nasal column and elevate the nasal tip. The ePTFE is utilized to augment the nasal dorsum and root, enhancing overall shape while being securely attached to the rib cartilage via the mortise and tenon structure. This configuration establishes a stable exogenous extension framework that also facilitates nose elongation. The safety and efficacy have been validated through over 10 years of clinical practice. Results: Over the past decade, we have performed this procedure in more than 500 cases without any complications, such as necrosis of the nasal column, ischemia of the nasal tip, or adverse graft appearances. Notable improvements in nasal morphology were observed across all patients. In addition, no postoperative restrictions on nasal ventilation were reported by any patient. Overall, patient satisfaction regarding surgical outcomes was exceptionally high. Conclusions: This framework represents an advanced implementation of exogenous extension stent concept, which is particularly effective for East Asians since it does not require a well-developed nasal septum to provide support. In addition, it does not increase the risk of restricted nasal ventilation. Level of Evidence: Level IV.