The outcome of temporalis fascia versus diced cartilage wrapped in temporalis fascia for dorsal augmentation in septorhinoplasty

Abstract

Objective: Rhinoplasty is a difficult operation and has the highest rates of revision surgery. It is often accompanied by septoplasty. Osseocartilagenous vault irregularity, radix depression and saddle deformity of the nose are common problems encountered in rhinoplasty. Deep temporalis fascia available in large quantity can be used alone or in combination with diced cartilage for augmentation rhinoplasty, and to camouflage the nasal dorsal irregularities. A wide variety of grafts is used to augment the nasal dorsum. The aim of the study was to note the nasofrontal, nasolabial, nasofacial angles measurements, functional and aesthetic assessment before and after septorhinoplasty. Methods: A retrospective chart review was done on 69 patients, who underwent septorhinoplasty at our institute (Jan 2011 – Jan 2014). Out of these, 31 patients underwent dorsal augmentation with temporalis fascia as a blanket endonasal coverage in one group and diced cartilage with temporalis fascia in the other group (38 patients). The diced cartilage was obtained from nasal septum in 16 cases (42.1%), chonchal cartilage in 14 cases (36.84%), rib cartilage in 5 cases (13.15%) and Goretex in 3 cases (7.89%) wrapped in temporalis fascia for dorsal augmentation was included in the same group.The operative details, surgical outcome, and complications noted have been mentioned. Results: The nasofrontal angle, nasal labial angle and nasofacial angle were reduced in the dorsal augmentation using diced cartilage with temporalis fascia group compared to the temporalis fascia alone group. As per the functional point of view (breathing quality) score, we found in the first group that all 31 patients were satisfied (100%), while in the second group we found that 37 patients out of 38 were satisfied (97.4%). Only one patient (3.2%) out of 31 patient in the first group was not satisfied form the aesthetic point of view while in the second group we found that 6 patients (15.5%) out of 38 were not satisfied. Conclusion: Temporalis fascia used in any form like a blanket, or with diced cartilage wrapped with fascia offers the advantage of smooth nasal dorsum, a reasonable functional improvement and a better option for nasal dorsal osseocartilagenous reconstruction.