The ENTific Centre
Autologous cartilage for Asian rhinoplasty
The advantages of using autologous cartilage grafts are the low infection rates, negligible risk of crossover infection associated with donor tissues and the relative cheap costs.
The disadvantages are donor site morbidity and the partial resorption of the grafts which can occur over time.
In many cases, most Asian patients do not tend to be overly concerned when faced with septal or conchal cartilage donor harvesting. A lengthier discussion usually is required when autologous rib harvests are discussed as the reconstruction material of choice.
As discussed earlier, the best material for augmenting the Asian nose is the septal cartilage. However this is usually insufficient in the Asian nose unless the requirement is only for minimal grafting volume e.g. a columella strut, a camouflage fill graft or a shield-cap graft. Hence alternative options include conchal and autologous rib cartilages.
The conchal cartilage is generally softer and curved. They do not respond as well to crushing or morselisation and fragment easily. Conchal cartilage is usually best used as camouflage and cap grafts; their natural convexity can be used to further enhance the nasal shape. They can also be used as septal extension grafts although the surgeon should take caution to use 'straighter ' conchal grafts ( see Figures 2a - c).
Autologous rib cartilage is plentiful for the demands of Asian augmentation. It remains the most useful and readily available source of autologous material for the Asian type augmentation rhinoplasties. Usually the 6th costal rib is used and harvested through an infra-mammary crease incision; additional rib grafts can also be taken from the adjacent 7th rib through the same incision.
Autologous rib grafts are however well known to have a tendency to warp especially when the rib has been trimmed and sculptured (Toriumi et al). This warping tendency should be monitored throughout the operative carving process. Ribs are placed into a saline-antibiotic mixture and tendencies to warp are usually evident within 30 minutes. The surgeon can then decide to use stable, un-warped rib grafts for septal extension grafts or in some cases, tailor the placement of a warped rib graft to use the curvature to the best advantage of the effect required.
To further minimize warping problems, the central portion of the rib is preferred to the cortex of the rib which has a tendency to warp more. Overall autologous rib grafts are an excellent choice in Asian rhinoplasty. Augmentation strategies usually require a significant amount of cartilage beyond what the nasal septum and ears can effectively provide for.