Use of Ethmoid Bone Grafts in Rhinoplasty

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.

Doctor Answers 17

Bone grafts and revision rhinoplasty

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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.

Manhattan Facial Plastic Surgeon

Rhinoplasty and Deviated Septum

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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 than 3 hours tops for an experienced rhinoplasty surgeon.
Maybe you should do some more research on the surgeons in your area.
Dr. S.

Oleh Slupchynskyj, MD, FACS
New York Facial Plastic Surgeon
4.8 out of 5 stars 285 reviews

Ethmoid bone grafts in rhinoplasty

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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
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Rhinoplasty and septal deviation

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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 standard with posterior deviations. The choice to use ethmoid bone for grafting is the surgeons, but, it is more difficult to work with than cartilage. our current surgeon may do exceptional work and you may want to stay with them but, if you are unsure there are other good surgeons.

Philip S. Schoenfeld, MD, FACS
Chevy Chase Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Seriously deviated septum

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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."

Ethmoid bone grafts in rhinoplasty

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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
4.8 out of 5 stars 158 reviews

Bone Grafts in Rhinoplasty Surgery

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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
4.9 out of 5 stars 43 reviews

Ethmoid Bone Grafts

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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
4.7 out of 5 stars 49 reviews

Ethmoid bone grafts for rhinoplasty/septoplasty

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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 can be called spreader grafts, septal struts, or even septal replacement grafts. In almost every case, a portion of septal cartilage is still available that can be harvested to serve this purpose. And in almost every case the "memory" of the crooked portion of cartilage can be overcome.

However, if the memory stil overpowers a cartilage strut, or no additioinal straight septal cartilage is available, then ethmoid bone is an option. For the surgeon, it's just an extension to the septoplasty, so it is convenient. More rigid too, and yet thin. So as a strut, it is an option. But truthfully things just don't usually get to that point.

One final point. This is for a crooked nose/crooked septum. The struts we describe above are in the deep tissue of the reconstruction. They do not really become part of the rhinoplasty (other than straightening things out), and therefore must be placed so that they are not palpable. That would be unnaturally rigid.

Kevin Robertson, MD
Madison Facial Plastic Surgeon
4.7 out of 5 stars 15 reviews

There are many ways of grafting.

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 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
4.8 out of 5 stars 38 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.