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Use of Ethmoid Bone Grafts in Rhinoplasty

asked 2 years ago by sharma80 in Toledo
Latest answer by William Portuese, MD
Question viewed 876 times
Tags: nose, deviated septum, revision, septum

I am considering Rhinoplasty in Missouri. I have met with a few ENT physicians and a few things have come up. I have a severely deviated septum. One is considering ethmoid bone grafts.

If done, the surgery would take five hours. Is this routine? It doesn't seem normal. I do I believe he specializes in revisions. What is the indication for ethmoid bone grafts? What are they for? When are they used in rhinoplasty? Also, why do some surgeons use internal splints and others do not?

Updated: 11/23/09

I wanted to thank EVERY DOCTOR who submitted a response to my question about ethmoid bone grafts. It was such an immense help and really made me narrow down who I choose to do my surgery. You all are the ones who make this a fantastic place for patients to come to.

17 answers to Use of Ethmoid Bone Grafts in Rhinoplasty

Bone Grafts in Rhinoplasty Surgery

Although bone grafts were frequently used in years past, most rhinoplasty surgeons today feel that cartilage grafts are much more reliable. The use of internal splints is individualized depending on the needs of each patient and the surgical techniques performed.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon

www.bevhills.com

Bone grafts and revision rhinoplasty

The problem with bone grafts is that they are not as dependable an alternative as cartilage grafts. Large surgical case series show that cartilage grafting in the nose produces long lasting dependable results. I think you can tell this from the consensus of opinions among the other surgeons. I also agree that 5 hours is likely too long as far as operative time is concerned even for revision surgery.

Guy Lin, MD
Manhattan Facial Plastic Surgeon

Rhinoplasty and Deviated Septum

Hi Sharma, I have never heard of ethmoid bone grafts. Maybe your surgeon is referring to the ethmoid bone plate which is an extension of your cartilagenous septum in the rear of your nose?? Severely deviated septums may require spreader grafts but cartilage is typically used for this. 5 hours is a very long time for any kind of rhinoplasty. Even revision rhinoplasties or very complex rhinoplasties should not take more that 3 hours tops for an experienced rhinoplasty surgeon. Maybe you... more

Oleh Slupchynskyj, MD
New York Facial Plastic Surgeon

www.facechange.org

Ethmoid bone grafts in rhinoplasty

Ethmoid bone is sometimes taken with septal grafts if there is not enough septum to work with. Usually there is enought septum for most grafting. A five hour rhinoplasty is extremely unusual.

Steven Wallach, MD
Manhattan Plastic Surgeon

Rhinoplasty and septal deviation

It would be unfair to make judgment about the time to repair your nose without seeing for myself how problematic your nose is. That said, 5 hours for a primary septorhinoplasty seems to be a bit excessive. Ethmoid bone grafts are used for rhinoplasty and for revision rhinoplasty, however, in primary rhinoplasty you should have ample cartilagenous septum to work with which is easy to harvest and very satisfying to work with. Removing portions of the ethmoid bone during septoplasty is... more

Philip S. Schoenfeld, MD
Chevy Chase Facial Plastic Surgeon

Seriously deviated septum

Dear Sharma, Please read the answer I just submitted regarding my own septoplasty experience. I went to Dallas from Seattle to Dr. Gunter and Dr. Cochran, his partner and had a perfect result. If you are not totally set on staying where you are, you might consider this too. It is listed under "Recommendations for revision rhinoplasty surgeons in Texas."

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon

Ethmoid bone grafts in rhinoplasty

Septal cartilage, not ethmoid bone is the primary choice for grafting in the nose. The posterior portion of the nose is ethmoid bone, which is very thin and does not add much structural contour to the nose. Five hours seems an excessively long period of time to undergo a rhinoplasty. Internal splints are no longer used in rhinoplasty and/or septoplasty because they have not been proven to be of any benefit.

William Portuese, MD
Seattle Facial Plastic Surgeon

www.seattlefacial.com

Ethmoid Bone Grafts

Hello, I prefer not to use Ethmoid bone grafts. I only use cartilage to straighten septum. Generally to straighten a septum, you don’t need grafts, just a well performed septoplasty. Sometimes, you may use spreader grafts. I use silicone splints following a septoplasty, and they will remain in the nose for one week following placement. Hope this helps answer your question. Dr. Nassif

Paul S. Nassif, MD
Beverly Hills Facial Plastic Surgeon

Ethmoid bone grafts for rhinoplasty/septoplasty

They are rarely used, and seem to be a last resort if nothing else is available. If the septum is severely deviated, then it is destabilized as part of the mobilization to allow it to return to midline. To keep the reconstruction straight, a plate of additional cartilage is often used as a strut or brace as it is secured to the unstable and straightened segment. Just like a casted broken arm. Depending on where they are placedand what additional function they may provide, these struts... more

Kevin Robertson, MD
Madison Facial Plastic Surgeon

Drastic times call for drastic measures. rhinoplasty, septal deviation and bone grafts

You may want to clarify this point with your plastic surgeon. As you can see from the comments below. this is not a conventional approach but you may not have a conventional nose. As we say, drastic times calll for drastic measures, and this may be so for your nose.

Otto Joseph Placik, MD
Chicago Plastic Surgeon

Ethmoid bone rarely needed

Hi Sharma, It sounds like you need a septoplasty to help with your breathing and a rhinoplasty to make the shape changes. When one does a septoplasty, the ethmoid bone is frequently removed as well as the deviated septal cartilage. The septal cartilage is often used to maintain an open airway or for use in shaping the nose. When septal cartilage is not available, ethmoid bone might be used or ear cartialge would be another option. Most rhinoplasty surgeons prefer to use cartilage rather... more

Timothy R. Jones, MD
Saint Louis Plastic Surgeon

Use of ethmoid bone grafts and internal splints in Rhinoplasty

I agree with most of the previous posts. In the absence of an examination, I cannot comment on the severity of YOUR septal deviation. If your septum is badly damaged, has been harvested, you need multiple straight long grafts (for struts or spreader grafts) the ethmoid may have to be used. As far as the length of surgery - it needs to last as long as it needs to last. As surgeons, we have all seen crappy results with both fast surgeons and slow surgeons. On the whole, the likelihood of... more

Peter A. Aldea, MD
Memphis Plastic Surgeon

Ethmoid bone grafts and rhinoplasty

Ethmoid bone grafts and rhinoplasty are very uncommon especially in a primary septorhinoplasty. Typically, there should be ample cartilage to work with in your nose to help correct the deviation. Bone grafts are very rigid and stiff and are sometimes useful in correcting a caudally deviated septum that is one deviated at the very end of the septum toward the tip of your nose. However, they typically part an unnatural or firm feel to your nose so I avoid them except in revision cases or... more

Scott Trimas, MD
Jacksonville Facial Plastic Surgeon

Ethmoid Bone Grafting in Rhinoplasty

As other surgeons have pointed out, the need to use ethmoid bone in rhinoplasty is quite rare. The ethmoid portion of the nasal septum makes up the superior bony portion of the septum and can be quite thin and fragile. It is generally only used in circumstances where other grafting options are not available. Due to its lack of flexibility, sharp edges, and lack of malleability, it is not a very suitable graft for use in the nasal tip. Because it is very thin, it doesn't provide a lot of... more

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon

www.drprendiville.com

Ethmoid bone grafts are not typically used during Rhinoplasty Surgery.

In general, cartilage and bone grafts are used to improve the appearance and function of your nose. You say you have a "severely deviated septum". Frankly, I'm not sure what your surgeon has in mind. Five hours seems a bit lenghthy to me as well. I like internal, thin, rigid Silastic splints after Septoplasty, when septal deviation is severe. You won't know they're present, and they remain in your nose for 2 weeks after Septoplasty. Their purpose is to keep your septum straight... more

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon

www.ericmjoseph.com

There are many ways of grafting.

I personally (in more than 30 years of rhinoplasty) have never had the need to use ethmoid bone. You should have enough septal cartilage and or bone to do the job. I feel that septal cartilage is the most reliable and stable grafting material. Nasal surgery in general is 1-2 hours long.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon

Rhinoplasty

Ethmoid bone grafts can be used in rhinoplasty surgery. 5 hours is not completely unheard of with significant septal or external nasal deformity. There are many choices for pieces to use for nasal reconstruction. The choice is usually surgeon dependent as there is no right or wrong answer identified through scientific study. There are several excellent rhinoplasty surgeons in Missouri. I noticed that you are near Columbia and I would suggest Dr. David Chang in Columbia or Dr. Keith... more