Ear Cartilage Use As a Spreader Grafts?

Question

Questions specifically regarding ear cartilage used as spreader grafts. I have read some doctors say that ear cartilage does not make a good spreader grafts and others say it is fine. What circomstances make spreader grafts with ear cartilage an appropriate option and vice versa? How is ear cartilage straightened so that can be used as a spreader graft? How much width is attainable with an ear cartilage spreader graft? Thank you in advance.

David C. Pearson, MD · Answer

As others have pointed out, the best cartilage for spreader grafts is septal (or even upper lateral) cartilage. It's a stiff hyaline cartilage and usually straighter, too, than the elastic conchal cartilage of the ear. That said, if septal cartilage is inadequate and the patient doesn't require the greater invasiveness of costal (rib) cartilage, then the ear can work just fine.

	I find that spreader grafts of any source are best when fixated into place with permanent sutures, but this is especially true for the more elastic ear cartilage.

	All the best,

	--DCP

	Pearson Facial Plastic Surgery®

Steven J. Pearlman, MD, FACS · Answer

Each situation has to be weighed in terms of what you are looking to achieve. Septal cartilage is strong and the best for grafts in rhinoplasty and revision rhinoplasty such as spreader grafts. Ear cartilage is next choice if the septal cartilage has been used or removed by prior septoplasty. The problem with ear cartilage is that it is soft and pliable. So it is good for volume, even spreader grafts but not to straighten a crooked nose. If a nose needs a lot of cartilage for grafts or needs straightening and septum is not sufficient, then I prefer rib cartilage.

Nima Shemirani, MD · Answer

Dear Louster225,

	
		Ear cartilage works well for spreader grafts and there are portions of the graft that are straight enough for the graft
	
		If they are a little curved, then can be used to straighten a crooked nose 
	
		We can also score the cartilage (put little cuts in the cartilage) to straighten it
	
		We usually use ear cartilage when the septum has been removed
	
		If you have not had a rhinoplasty or septoplasty before, then the first choice should be the septum
	
		If your surgeon is not comfortable using septum, it may be a sign that you should find a rhinoplasty specialist who routinely performs this type of procedure


	Best regards,

	Nima Shemirani

	Best regards,

	Nima Shemirani

William Portuese, MD · Answer

Ear cartilage is only used for grafting purposes if the nasal cartilage has been completely harvested from previous surgery, and there is a cartilage depleted nose present at the time of the rhinoplasty. A spreader graft is typically 2-3 mm thick and when placed bilaterally and give 4-6 mm of augmentation of additional width. Please see the link and the video below for examples of spreader grafts placed in our rhinoplasty practice

Roy A. David, MD · Answer

Septal cartilage is usually the first choice for spreader grafts due to it's firmness and straighter contour, however when septum is lacking ear cartilage can also be used. It is more work for the surgeon, and usually costlier for the patient, but any subtle irregularities will be obscured by the upper lateral cartilages which "sandwich" them in place.

Donald Nunn, MD (retired) · Answer

The best cartilage for spreader grafts are septal cartilage. If this is not available because of previous surgery then ear or rib cartilage can be used. The ear cartilage is curved and somtimes has variable thickness but can work. Sutures are used to straighten the ear cartilage and secure in position. Adequate width and thickness is usually not a problem. Donald R. Nunn MD Atlanta Plastic Surgeon.

Ear Cartilage Use As a Spreader Grafts?

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