Ear cartilage or rib cartilage for spreader grafting for one-sided collapsed internal nasal valve?

Question

Septum is totally reduced so I'll have to choose - ear or rib graft for spreader grafting? What is the best for the nose? Surgeon said probably rib graft, but if I don't want ear graft will be fine as well. Are rib grafts better? What is the difference? Maybe ear grafts are not strong enough? Thank you for advice

Alejandro Nogueira, MD · Answer

The ideal is a straight, flat and firm cartilage, and such donor is optimally the septum.
Rib is always the last resort, too aggressive, painful and scarred donor site.
Ear may work too.
In my practice it is not uncommon I can perform uni or commonly bilateral spreader / spacer grafting (as long as they don't have to act as caudal extension grafts) with spare parts from a large hump or large alar cartilages removed (if this is the case).
I understand yours is a revision, I assume there is no more excess of dorsum or alar cartilages, so some donor site has to be touched; ideally is septum, if not available then ear; never rib but in extremey and atypical disfavorable scenarios.Important comment: the collapse of the internal nasal valve IS NOT treated with spreader grafting, at all, that is a fundamental and conceptual error; spreader grafting is for middle vault pinching and inverted-V deformity treatments (normally without functional impairement); nasal valve collapse happens at issues on the lateral crura of the lower lateral (or alar) cartilages, and the treament is with fibrotic release, debridement, batten grafting and sometimes rim grafting, a classical standard pack.
If you wish better grounded opinion well lit, focused and standard images have to be assessed: frontal, both lateral and both oblique views, also underneath the nostrils.
Feel free to request any additional information from me.

Paul N. Afrooz, MD · Answer

Regarding cartilage grafts, there are several things that must be considered.  First and foremost is the flaw, deformity, or functional problem that is to be corrected.  The ear is a very favorable source of cartilage, and can be harvested from within the same operative field during surgery, meaning that the surgeon does not have to move to the chest to harvest rib cartilage.  However, ear cartilage is soft and supple in comparison to rib cartilage.  If firm structural support is required for correction, rib cartilage is typically the best source for this indication.

Ear cartilage or rib cartilage for spreader grafting for one-sided collapsed internal nasal valve?

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Ear cartilage or rib cartilage for spreader grafting for one-sided collapsed internal nasal valve?

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Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.