Risk of using septal cartilage for nasal valve surgery.

Question

My ENT is referring me to a plastic surgeon for nasal valve collapse correction. It is quite severe even at rest. I have already nasal nerve damage and dryness. Is there some risk of further damage using septal cartilage and if so is ear cartilage acceptable for alar batten grafts?

Jacob Sedgh, MD · Answer

There are two types of nasal valves: external nasal valve which is at the level of the nostril margins and internal nasal valve which is at middle vault (above the nasal tip but further deep inside). Issues of constriction and collapse at either site can cause breathing problems and their repair may often require reinforcement or restructuring with cartilage grafts.

The two most common types of grafts used in rhinoplasty are septal and auricular (ear) cartilages.

Septal cartilage has the advantage of being available at the surgical site, usually more abundant and often intrinsically stronger. However, ear cartilage is also a viable alternative in most cases and its natural curvature at times can even be desirable, obviously depending on the individual case.

William Portuese, MD · Answer

Nasal cartilage is the preferential type of cartilage to use for spreader grafts and alar batten grafts when there's valve collapse. Ear cartilage is only when there's a cartilage depleted nose from a prior  rhinoplasty.

Kimberley Rutherford, MD · Answer

Thank you for your question. There are several ways of correcting nasal valve collapse depending on the location of collapse (internal vs. external nasal valve).  For alar batten grafts, my donor site of choice is the septal cartilage if no previous septal surgery has been performed. It is in the same surgical field and often provides enough cartilage and adequate support.  If there is not enough septal cartilage, auricular cartilage is acceptable. However, this requires separate surgical site and can cause moderate ear pain after the surgery.  Other options for grafting for weak lower lateral cartilage include your own rib cartilage, irradiated donor rib cartilage, or even turn-in flaps from the lower lateral cartilage.  Regarding your question of risks of using septal cartilage, they typically are the same as risks of a septoplasty and are minimal in the right set of hands.  Be sure to consult with a  facial plastic surgeon or plastic surgeon who has significant experience with this type of procedure.

Mark D. Wigod, MD · Answer

Septal cartilage is considered by most to be the preferred source for nasal surgery grafts.  It is in the same operative field, there is little donor site morbidity if properly harvested, and it is rigid enough to provide needed support.  If it is not available, ear cartilage is acceptable.  Rib can be used, but is much more involved.  If the tip cartilages have not been trimmed and are of adequate size, they can be turned over upon themselves for external valve surgery or rotated superiorly for the internal valves.  Upper lateral cartilage, if sufficient, can also be turned in upon itself as a spreader flap and avoid septum use.

Fred J. Bressler, MD, FACS · Answer

I prefer nasal septal cartilage over ear cartilage for alar batten graft repair of alar nasal valve collapse. If you have already had surgery on your septum and do not have enough cartilage material for safely harvesting the grafts, then ear cartilage, rib cartilage or irradiated donor rib cartilage can also be considered. An experienced rhinoplasty specialist can help recommend your best options by examining your nose and reviewing your medical history. Nasal dryness is a separate but perhaps related issue, and may require medical topical washes, alternation of Rx antihistamines and other measures to address. Best wishes.

Risk of using septal cartilage for nasal valve surgery.

Answers (5)

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