The donor cartilage being used is usually septal cartilage. This is provided that there is enough septal cartilage left. If the cause of the saddle deformity is such that all the cartilage in the nose has been depleted, then an ear cartilage graft will be used to build this area up.
What Kind of Donor Cartilage is Used to Correct a Saddle Deformity During a Septoplasty?
Doctor Answers (8)
Usually rib cartilage, but septal or ear cartilage may also be used.
Usually rib cartilage is used, although sometimes if the deformity us not extensive septal or ear cartilage can also be used. In some case Weiss bone graft from the scalp beneath the hairline. The scalp has an inner and an outer layer of bone; the outer layer is used for saddle reconstruction.
Saddle deformity provides lots of options for correction.
There are a variety of sources for cartilage for reconstruction of the saddle deformity. A saddle deformity is when the top of the nose becomes scooped out either from trauma or previous surgery. To correct this, the dorsum or bridge of the nose needs to be built back up. Most often this is done with cartilage from the septum which can be layered and contoured as needed to give the profile that the surgeon and the patient desire. Other options include cartilage from the ear as well as from the rib. In addition, irradiated cartilage can be used from tissue banks. This is cartilage from cadaveric donors that has been treated and radiated. It has been shown in studies to have a very good safety record as well. Recent studies have confirmed that it has good durability and safety. Lastly, some surgeons will use synthetic implants to correct a saddle nose deformity. This includes materials such as GoreTex and silicone.
Correction of a saddle nose deformity is a challenging procedure for a facial plastic surgeon. Fortunately, there are a variety of materials both from the patient as well as from elsewhere that can be used to correct this deformity.
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Cartilage Used to Correct a Saddle Deformity in Rhinoplasty
There are a number of alloplastic and autoplastic materials that have been used successfully. Silastic implant, septal cartilage, irradiated cartilage or rib cartilage all will do well in the experienced hand. And that is the key. Obtain several consultations and ask for length of follow ups.
Correction of this type of deformity requires a graft or implant. What type is chosen can depend on whether only aesthetic profile correction is needed or if structural support (as in loss of the caudal septum) is needed as well. It also depends on the surgeon's experience and preference. Some surgeons will only use the patient's cartilage (septum, ear, rib) and never use a synthetic implant. Some are very comfortable with synthetics. There are pros and cons to each and there is also the patient's preference and level of risk acceptance. Cartilage may require additonal operative time and additional surgical sites to heal (ear, rib) and may over time show some irregularites, resorbtion or shifting. It will never need to be removed because of infection. Implants do not need additional OR time, are manufactured and so are always symmetrical. They are very appealing to use but definitely carryy the risk of shifting or infection. If they become infected they must be removed surgically.
What kind of graft is required to fix a saddle nose deformity?
Augmenting the nasal bridge, with a dorsal graft, IMHO is the best way to correct a saddle deformity. IMO< rib cartilage, bone, irradiated cartilage and folded ear cartilage all dissolve unevenly with time and for that reason, I don't use them but prefer a straight silastic nasal implant.
Saddle nose, rhinoplasty
typically cartilage is harvest from one's own body. The most common source is the septum or the middle part of the nose. If this is not available, then the other options are the ear cartilage or the ribs.
The ribs are likely to be the best source of cartilage to correct saddle nose deformities.
sometimes you maybe able to avoid rib cartilage harvest, by utilizing ear cartilage that is braced with a resorbable plate to give it rigidity or more structure.