Auricular Cartilage Grafts and Revision Rhinoplasty Operations

Grafts Obtained From Auricle Cartilage In Nose Surgery

Auricular cartilage grafting procedure

Auricular cartilage is often preferred as a source of cartilage grafts in nasal surgery.

Why use auricular cartilage grafts?

Generally, in patients who have had previous nose surgery and not enough cartilage tissue in the nose, ribs and auricle cartilages belonging to the patient's own body are used.

How to get auricular cartilage graft?

Auricular cartilage grafts can be performed under local anesthesia. After local anesthetic is injected into the anterior and posterior part of the auricle, incision is usually made on the posterior aspect of the auricle, and auricular cartilage graft is removed by submucopericondrial dissection. During the procedure, it is important to prevent damage to the antihelix and helix folds of the auricle, to protect the natural cartilage protrusions and to prevent aesthetic problems after the procedure. After removal of the auricular cartilage graft, a full-thickness suture can be made using antibiotic pomade-impregnated sterile gases, as shown in the photo on the anterior and posterior of the auricle, to prevent dead space and bleeding control. After 5-7 days, gauze can be removed.

What are the advantages of using auricular cartilage grafts over rib grafts?

Cartilage removal from the auricle has the following advantages over rib cartilages:

- Cartilage tissue is easier to reach and process
- Except for the aesthetic deformity due to cartilage removal from the auricle, there are no serious health risks. There is a risk of damage to the lung during cartilage removal and the possibility of pain that does not respond to painkillers after the procedure and lasts up to several months.
- The procedure can be performed under local anesthesia, the patient does not need to get general anesthesia unnecessarily.
- Risk of spontaneous rotation and skewing after rib cartilage is fresh (hence oblique incision techniques have been described)
- In patients aged 30-40 years and older, there is a risk of rib cartilage calcification, and in older patients, radiographs may be required prior to the procedure, and the patient may need to be informed of calcification (irradiated cadaveric rib graft, not belonging to the patient).

What are the disadvantages of using auricular cartilage graft compared to rib grafts?

Rib cartilages are more robust than the auricle cartilages and are more suitable for use as supportive tissue.

Rib cartilages have the following advantages over cartilage removal from the auricle:

- Rib cartilages are more suitable for reconstruction of the nasal tip support
- It is particularly advantageous in noses with thick skin characteristics and augmentation of the nasal dorsum, such as ethnic revision nasal aesthetic surgery
- In the revision nasal surgeries that require a large amount of cartilage tissue, the desired amount of graft can be removed from the patient's own tissue.

Auricular cartilage grafting time

On average, the removal of cartilage from a pinna varies between 30-45 minutes for a single ear, including the duration of local anesthetic injection.

How should the patient care after the auricular cartilage grafting procedure?

Postoperative patient care after auricular cartilage grafting procedure

Antibiotic gauzes placed in front of and behind the auricle and mutually sutured are removed after 5-7 days after the procedure. Generally, it is appropriate to avoid water contact with the auricle in the first 3 weeks after the procedure. Since I use absorbable suture, it is appropriate to apply antibiotic ointment on the sutures behind the auricle. Generally, after painful gauze sutures are removed, the pain experienced by the patients decreases. The first week may be appropriate to use simple painkillers. During sleep, it is appropriate not to lay on the ear for the first 3 weeks.

One Week After Auricular Cartilage Grafting

One Week After Auricular Cartilage Grafting

Areas of use of auricular cartilage grafts during revision nose aesthetic purposes

During revision ethics nasal operations, auricular cartilage grafts can be used for the following purposes:

- augmentation of the nasal dorsum (augmentation rhinoplasty with auricular cartilage graft). For this, cartilage powder or small fraction may be used.
- Supporting the outer legs of the alar cartilage
- nasal valve surgery
- alar rim graft
- treatment of asymmetric subcutaneous cavities

Furthermore, auricular cartilage grafts can be used in different graft applications. However, I do not like to use auricle cartilage as columellar strut graft in patients with poor nasal tip support. As it is soft and flexible, it can stretch over time and sagging at the tip of the nose, unlike the cartilage of the ribs and nasal septum. If possible, I prefer to prepare columella grafts from the remaining part of the nasal septum or using rib cartilage.

About revision nose surgeries

Revision rhinoplasty is a nose aesthetic surgery taht performed on patients who have undergone previous nasal surgery. It is called secondary rhinoplasty when nasal esthetics are performed for the second time, and tertiary rhinoplasty when nasal esthetics is performed for the second time. Revision nose surgeries can be classified in many different ways from simple to complex. For example, performing a second procedure at the tip of the nose can be called as revision nose tip aesthetics; A cosmetic nose surgery including complete nasal bone crushing is called revision rhinoplasty.

Revision nose aesthetic surgery before and after video

The comments of the patients who have previously had rhinoplasty surgery and are not satisfied are sometimes not consistent with what we see during the surgery. For example, in a patient who said "I think only cartilage slipped on the tip of my nose," we saw that there was a suture reaction on the tip of the nose during surgery, or that a patient who said "cartilages on my nose turned sideways" turned the side as a result of the healing process of the nose as a result of the asymmetric cartilages in the nose. Nose aesthetic surgery is not a risk-free photo application. Not every revision surgery is performed solely because of the doctor's mistake. In the nasal aesthetic surgeries, all aesthetic nasal surgeries after the first operation are more difficult and more complex. It requires knowledge, experience and foresight. We usually proceed with the procedure by seeing normal anatomical structures, cartilage, connective tissues under the skin and some anatomical details that guide us during the procedure. In patients with revision nasal esthetics, we may have to continue the surgery under the skin as if it were a cardboard cut or cardboard cut. The membrane of the cartilage can be dissected more easily and the skin can be treated more easily in primary nasal aesthetic surgeries....

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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