Use of 6-Year-Old Preserved Autogenous Septal Cartilage in Secondary Rhinoplasty

Abstract

It is common practice in septorhinoplasty operations to preserve excess septal cartilage removed during the surgery in either saline and antibiotic or an alcohol solution for possible future use [1,2]. However, no major clinical report has indicated the optimal time of autogenous septal cartilage storage. We present a secondary rhinoplasty case in which we used autogenous septal cartilage that had been preserved in isopropyl alcohol for 6 years. The patient, a 28-year-old man, had undergone a septorhinoplasty operation 6 years previously at another hospital. Postoperatively, he was given pieces of his septal cartilage in an alcohol solution for storage with no further information. After 1 year, a nasal vault and tip deformity developed, but the patient refused any kind of secondary intervention. The patient presented himself to our unit 6 years later for correction of his nasal deformity (Fig. 1). A secondary rhinoplasty procedure, which required a considerable amount of cartilage graft, was planned. The patient demanded the use of the aforementioned preserved cartilage in this procedure. Before surgery, microbiologic studies showed no bacterial growth, whereas the histology study showed areas of chondroid tissue along with connective tissue (Fig. 2). During surgery, the cartilage was washed copiously with polyvinyl iodine and antibiotic solutions. Additional unilateral conchal cartilage had to be harvested because the preserved cartilage was insufficient for all the procedures. Preserved cartilage and fresh conchal cartilage were diced and prepared as two separate Turkish delights as described by Erol [3]. Fresh cartilage was used mainly for the supratip and tip regions, whereas the preserved cartilage was used only for bony dorsum augmentation. The patient s follow-up period of 6 weeks was uneventful until an acute swelling and erythema developed over the preserved cartilage area: the cephalic nasal dorsum. Wide spectrum antibiotics were begun immediately. Fluctuation developed 1 week later over the region, and a drainage attempt through the nasal mucosa produced a malodorous purulent material. Localized nasal inflammation settled in 2 weeks and left no sequel in the skin but dorsal depression (Fig. 1). The fresh cartilage area was apparently not affected. At his 8-month follow-up evaluation, the patient was barely satisfied with the outcome and consented to undergo a tertiary procedure once the tissue remodeling was over. We believe that with this case, we had the opportunity to compare diced fresh and 6-year-old preserved cartilage in the same secondary rhinoplasty patient. Although it is only a single case, it showed that autogenous cartilage preserved for an extended period in alcohol preservation may fail as graft material. It can be speculated that isopropyl alcohol is not a good storage media. We do not believe the infection encountered was a simple infection. Otherwise, all the diced grafts would have been lost. Further reports are necessary for a conclusion as to the type of preservation solution and length of time required for storage of viable cartilage.