However, the use of homografts carries with it the possibility of disease transmission and unpredictable resorption rates. In addition, they are less likely to warp than costal cartilage. They offer the same advantages as alloplastic grafts but are less prone to foreign body reaction. HomograftsĪcellular dermis and irradiated cartilage are 2 homografts that have gained popularity over the past several years5-6. The use of alloplastic grafts has become less popular for these reasons. In addition, they can lead to a foreign body reaction with resultant damage to the overlying skin. Unfortunately, these materials have a higher rate of infection and extrusion than autologous materials. The main advantage of such implants is that they are readily available and therefore save time and avoid donor site morbidity. There are a number of alloplastic implants available including polytetrafluoroethylene, porous polyethylene and silicone1-4. However, this cartilage is relatively weak and irregular in shape, which may make it unsuitable when a strong dorsal strut is necessary such as with a saddle nose deformity or following neoplastic resection. Ear cartilage is commonly used for tip, alar batten, alar strut, spreader, and columellar strut grafts. The donor site is well-hidden and post-operative ear deformity is uncommon. It is relatively easy to harvest through a post auricular incision or through a conchal incision when a composite chrondrocutaneous graft is necessary. This is particularly true in congenital rhinoplasty patients where the septum tends to be foreshortened.Įar cartilage is more abundant than septal cartilage. The disadvantage is that most people do not have enough septal cartilage for the work that is necessary. It is generally stronger than auricular cartilage making it a good choice for minor tip work and dorsal augmentation. Septal cartilage can be easily harvested during septoplasty, thereby requiring no additional prepping or incisions. Septal and auricular cartilages are potential alternative graft sites. In the senior author’s experience, rib cartilage can be harvested in less than 30 minutes. Finally, it is relatively easy to harvest using a small incision. Examples of such situations include nasal reconstruction following tumor resection, saddle nose deformity, ethnic rhinoplasty, congenital deformity, and revision (secondary) rhinoplasty. There are several situations where abundant, strong cartilage is necessary, precluding the use of other grafting materials.
It is also more abundant and usually stronger than other cartilages. First of all, it is versatile and can be carved into many different shapes and sizes depending on the patient’s deformity. It has several advantages when compared to other autologous grafts. Autologous costal cartilage is an excellent source of grafting material in the nose.
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