The objective of this study is to present an algorithm for choosing graft materials for the reconstruction of severe caudal and/or dorsal septal cartilage abnormalities and to examine the long-term results obtained with these techniques. Retrospective review of 21 consecutive cases of caudal and/or dorsal septal reconstruction via the external approach using the algorithms is presented. The techniques used are carefully described. Patient survey at least 1 year after the initial procedure, rhinologic examination before and after the procedure, and photographic analysis of preoperative and postoperative views are presented. The graft choice algorithm presented helps the surgeon to consider appropriate graft choice alternatives before surgery.
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References
1.
FomonS., SyracuseV.R., BolotowN., PullenM.Plastic repair of the deflected septum.Arch Otolaryngol44: 141–156, 1946.
2.
KingE.D., AshleyF.L.The correction of the internally and externally deviated nose.Plast Reconstr Surg10: 116–120, 1952.
3.
KasperbauerJ.L., FacerG.W., KernE.B.Reconstructive surgery of the nasal septum. In: PapelI.D., NachlasN.E., eds. Facial Plastic and Reconstructive Surgery.St. Louis, Mo.Mosby Yearbook Co, 337–343, 1992.
4.
ReesT.D.Surgical correction of the severely deviated nose by extramucosal excision of the ossesocartilaginous septum and replacement as a free graft.Plast Reconstr Surg78: 320–330, 1986.
5.
GubischW.The extracorporeal septum plasty: A technique to correct difficult nasal deformities.Plast Reconstr Surg95: 672–682, 1995.
6.
SlavitD.H., BansbergS.F., FacerG.W., KernE.B.Reconstruction of caudal end of septum: A case for transplantation.Arch Otolaryngol Head Neck Surg121: 1091–1098, 1995.
7.
JugoS.B.Total septal reconstruction through decortication (external) approach in children.Arch Otolaryngol Head Neck Surg113: 173–178, 1987.
8.
ConessaC., TomasiM., CharpentierP., SaigasP.La depose repose de cartilage septal dams les nez devies tramatiques.Ann Oto-Laryngol Chir Cervicofac111: 132–140, 1994.
9.
ToriumiD.M.Subtotal reconstruction of the nasal septum: A preliminary report.Laryngoscope104: 906–913, 1994.
10.
ToriumiD.M., ReisW.R.Innovative surgical management of the crooked nose.Facial Plast Surg Clinics1: 63–78, 1993.
CanadianiP., CampiglioG.L., RizzoF., GainiR.Anatomical reconstruction versus camouflage of the inferior two thirds of the nasal septum.Ann Plast Surg34: 625–630, 1995.
13.
DanielR.K.Rhinoplasty and rib grafts: Evolving a flexible operative technique.Plast Reconstr Surg94: 598–611, 1994.
14.
RomoT., JablonskiR.D.Nasal reconstruction using split calvarial grafts.Otolaryngol Head Neck Surg107: 622–630, 1992.
WaldmanS.R.Gore-tex for augmentation of the nasal dorsum: A preliminary report.Ann Plast Surg26: 520, 1991.
17.
GodinM.S., WaldmanS.R., JohnsonC.M.The use of expanded polytetrafluoroethylene in rhinoplasty: A six year experience.Arch Otolaryngol Head Neck Surg121: 1131–1136, 1995.
18.
CarterW.W.Transplantation of bone for the correction of depressed deformities of the nose with report of cases.Laryngoscope21: 94–97, 1923.
19.
CarterW.W.The ultimate fate of bone when transplanted into the nose for the purpose of correcting a deformity.Arch Otolaryngol15: 563–573, 1932.
20.
MowlemR.Bone and cartilage transplants their use and behavior.Br J Surg29: 182–193, 1941.
21.
SmithJ.D., AbramsonM.Membranous versus endochondral bone autografts.Arch Otolaryngol99: 203–205, 1974.
22.
ZinsJ.E., WhitakerL.A.Membranous versus endochondral bone: Implications for craniofacial reconstruction.Plast Reconstr Surg72: 778–785, 1983.
23.
PhillipsJ.H., RahnB.A.Fixation effects on membranous and endochondral onlay bone-graft resorption.Plast Reconstr Surg82: 872–877, 1988.
24.
LinK.Y., BartlettS.P., YaremchukM.J., FallonM., GrossmanR.F., WhitakerL.A.The effect of rigid fixation on the survival of onlay bone grafts: An experimental study.Plast Reconstr Surg86: 449–456, 1990.
