Pressure necrosis of septal cartilage associated with bilateral extended spreader grafts in rhinoplasty.
OBJECTIVE
To investigate septal cartilage compressive changes as a result of bilateral extended spreader grafts (ESGs), which are commonly used in rhinoplasty. The buckling, rupturing, or necrosis of the recipient site leads to nasal tip structural deformity. These pathologic changes associated with bilateral ESGs warrant the clinician's attention and in-depth basic and clinical research.


METHODS
The basic experimental study involves New Zealand rabbits, randomly assigned to groups A, B, C, and D, with group A as a reference. The right auricular cartilage was harvested and transplanted into a corresponding anatomic location of the left ear. The compressive effect was studied by gross observation and microscopic examination with hematoxylin-eosin staining after 3 months. In a clinical experiment, revision rhinoplasty surgical procedures were performed in 10 human patients 6 months to 1 year after placement of bilateral ESGs. The compressive changes of septal cartilages between the ESGs were observed intraoperatively.


RESULTS
In group A of the rabbits, no pathologic change was noted, but 2 cases of attenuation were observed in group B (33.3%), 6 cases of central fracture (100%) with 1 case of perforation (16.7%) in group C, and 6 cases of different degrees of defects in group D (100%). Clinical intraoperative observations revealed 1 case of defects and necrosis (10%), 4 cases of attenuations and cracks (40%), and 5 cases of attenuations (50%).


CONCLUSIONS
Septal cartilage compressive necrosis leading to structural damage by bilateral septal ESGs is a clinically significant complication of rhinoplasty. Owing to its affect on the viability of the original septal cartilages, we believe the unilateral ESG with columellar strut is preferred, especially in Asian patients.
Jung
Dong-Hak
DH
Shimmian Rhinoplasty Clinic, 211, Seocho Hyundai Tower, 1319-13, Seocho-dong, Seochu-gu, Seoul 137-070, South Korea. doctorshanlei@gmail.com
Chang
Geun-Uck
GU
Shan
Lei
L
Liu
Da-Lie
DL
Wang
Zhi-Jun
ZJ
Tian
Hong-Jun
HJ
Chen
Can
C
Han
Wade W
WW
D000328:Adult; D000818:Animals; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D023421:Models, Animal; D009300:Nasal Septum / Q000473:pathology*; D009336:Necrosis; D011183:Postoperative Complications; D011312:Pressure; D011817:Rabbits; D011897:Random Allocation; D012225:Rhinoplasty / Q000379:methods*; D016896:Treatment Outcome