Subtotal reconstruction of the nasal septum using a conchal reshaped graft.

Abstract

The caudalmost section of the cartilaginous nasal septum performs the important function of supporting the middle and lower third of the nose. Its absence leads inevitably to deformation of the nasal pyramid and collapse of the internal nasal valve. The most frequent causes of its loss are iatrogenic and traumatic, and the mucoperichondrial lining remains intact in most cases. A graft of conchal cartilage constitutes the preferred method of reconstruction due to the capacity of the transplanted tissue to acquire characteristics of shape, elasticity, and strength closely resembling those of the original tissue to be replaced. The auricular concha differs in anatomic shape from the nasal septum and tends, when deformed, to return to its initial appearance due to cartilaginous memory. The auricular cartilage is also less robust than the quadrangular. The paper describes a surgical technique for reshaping of the conchal cartilage that makes it possible to obtain a practically straight conchal graft that will retain its stability over time with no risk of subsequent modification. The technique involves a double figure-of-8 suture together with incisions on the concave side of the graft for straightening purposes. The simultaneous use of 2 spreader grafts taken from and attached to the concha itself helps to maintain straightness and reinforce the structure. The graft is then placed in position via open access and secured between the 2 mucoperichondrial flaps after these have been carefully detached. The tissue and technique used make it possible to restore the original condition in anatomic and physiological terms, eliminating the esthetic impairment and regaining respiratory functionality.