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BACKGROUND Although it has been common to use artificial implant to augment nasal dorsum in Asian rhinoplasty, the demand for not using it is increasing due to the long-term complications of implants. However, if only the tip is raised without raising the dorsum with implant, it is difficult to avoid supratip depression, so it is difficult to obtain good cosmetic results. The authors would like to report good results, performing an augmentation rhinoplasty that raises the supratip area using the nasal septal cartilage without using an implant. METHODS Septal gap graft was used in 22 patients undergoing nasal tip surgery from January 2019 to April 2021. Septal gap graft refers to a graft that increases the height of the supratip area by using septal cartilage. Firstly, the authors perform a septal extension graft using the septal cartilage, then the authors fix the lower lateral cartilage in an ideal position, and lastly the authors heighten the nasal tip with onlay graft. The height difference between the nasal bone and the nasal tip, is solved by placing the septal cartilage. Before, during and after surgery, photometric analysis was done by taking clinical pictures. RESULTS Through the septal gap graft, the supratip depression index was decreased and the nasal tip projection was increased. It was confirmed that the septal gap graft was well maintained at long-term follow-up, and the patients' postoperative satisfaction was also high. CONCLUSIONS The authors presented a new technique for augmentation rhinoplasty in Asians. Septal gap graft can be used safely and effectively to raise supratip area without using implant.

Importance: Having a noninvasive tool that quantifies the amount of remaining septal cartilage in the setting of prior septoplasty would be useful for surgical planning and patient counseling. Obje...

Several rhinoplasty and nasal reconstruction procedures require cartilage. Various studies have reported on the nasal septal cartilage as a donor site for Caucasian and Asian populations. However, studies regarding the Thai nasal septal cartilage dimensions are rare. This study aimed to examine the length, height, area, and thickness of the nasal septal cartilage, along with implications of the size and quantity of the available cartilage, for grafting in Thai cadavers. We analyzed the nasal septal cartilage in 42 Thai cadavers. The length, height, area, and thickness were digitally measured using ImageJ 1.52 software, along with the size and area of the available cartilage for grafting after preserving a 10-mm L-strut. Data were compared between sexes. The mean height, length, and area of the nasal septal cartilage were 30.96 ± 5.90 mm, 26.13 ± 6.90 mm, and 636.10 ± 196.13 mm2, respectively. The length did not differ significantly between sexes. However, the height and area in male cadavers were greater than those in female cadavers. The mean thickness ranged from 0.77 to 1.02 mm depending on the area, with the thickest and thinnest areas being the superoposterior and inferoposterior parts, respectively. The mean height, length, and area of the harvestable cartilage were 20.96 mm, 16.13 mm, and 384.84 mm2, respectively, after excluding the L-strut. Our results provide major anatomical data of the Thai nasal septal cartilage. Its implication for use of the septal cartilage for grafting is 21 mm in height and 16 mm in length, which is sufficiently safe to maintain nasal support. This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Naso-orbital-ethmoid （NOE） fracture is relatively common in midfacial regions, but management remains challenging. Here we report a novel technique using nasal septal cartilage to correct para-nasal soft tissue asymmetry in a 17-year-old Japanese male 6 months after surgical treatment of fractures in the NOE complex. An otorhinolaryngologist harvested the septal cartilage during nasal septoplasty to correct a deviated septum that was planned to coincide with removal of the plates 6 months after the primary surgery. The maxillofacial surgeons then grafted the septal cartilage into the concave area in the right para-nasal region and fixed it with a bioresorbable screw after removal of the right plate via a transconjunctival approach. The postoperative course was uneventful and the patient was satisfied with the cosmetic outcome after 9 months postoperatively. Septal cartilage could be an effective grafting material for correction of postoperative midfacial concave deformity following repair of an NOE fracture.

Tension pneumosella (TP) is a rare entity reported as the invagination of the sphenoid sinus mucosa into the skull base after endonasal transsphenoidal surgery. Few studies have reported on TP, and in these studies, invagination is confined to either the intrasellar or suprasellar area. We encountered a case of unexpected prominent TP toward the intracranial space 5 years after endoscopic endonasal transsphenoidal surgery (EETS) for a nonfunctioning pituitary adenoma. In addition, we present a hypothesis of the underlying mechanism by a pressure gradient change between the extracranial and intracranial space in TP formation. For repair, a pedicled nasal septal flap was fabricated from the remaining part of the septal mucosa, and a pedicled inferior turbinate flap was created. Moreover, the nasal septal cartilage was used as a rigid support for reconstruction, which was useful for preventing TP recurrence. This is the first report of an unexpected prominent TP after EETS. It is important for otorhinolaryngologists and neurosurgeons to be aware of the possibility of TP following EETS. Laryngoscope, 1798-1801, 2018.

The nasal septal cartilage plays an important role in the growth of midface and as a vertical strut preventing the collapse of the nasal bones. The repair of nasal cartilage defects remains a major challenge in reconstructive surgery. The tissue engineering strategy in the development of tissue has opened a new perspective to generate functional tissue for transplantation. Given the poor regenerative properties of cartilage and a limited amount of autologous cartilage availability, intense interest has evoked for tissue engineering approaches for cartilage development to provide better outcomes for patients who require nasal septal reconstruction. Despite numerous attempts to substitute the shapely hyaline cartilage in the nasal cartilages, many significant challenges remained unanswered. The aim of this research was to carry out a critical review of the literature on research work carried out on the development of septal cartilage using a tissue engineering approach, concerning different cell sources, scaffolds and growth factors, as well as its clinical pathway and trials have already been carried out.

IMPORTANCE: This study characterizes and compares common surgical manipulations’ effects on septal cartilage to understand their implications for rhinoplasty outcomes based on cell viability and cartilage health. OBJECTIVE: To illustrate distinct differences in the impact of various surgical manipulations on septal cartilage in an in vitro septal cartilage model. A secondary objective is to better understand the chondrocyte’s response to injury as well as how alterations in the extracellular matrix correspond to chondrocyte viability. DESIGN, SETTING, AND PARTICIPANTS: In this bench-top in vitro porcine model using juvenile bovine septal cartilage from bovine snouts, easily obtainable septal cartilage was used to generate large numbers of homogenous cartilage specimens. Quantitative outcomes at early and late time points were cell viability, cell stress, matrix loss, and qualitative assessment through histologic examination. The study was performed at a single academic tertiary care research hospital. INTERVENTIONS: Four common surgical manipulations were contrasted with a control group: crushed cartilage, scored cartilage, diced cartilage, and shaved cartilage. MAIN OUTCOMES AND MEASURES: Following the manipulation of the cartilage, the quantitative outcomes were glycosaminoglycan release to the media, lactate dehydrogenase release to the media, and cell death analysis through apoptosis staining. The qualitative outcomes were histologic staining of the manipulated cartilage with safranin-O/fast green stain to identify proteoglycan loss. RESULTS: The crushing followed by shaving manipulations were the most damaging as indicated by increased levels of lactate dehydrogenase release, glycosaminoglycans loss, and cell death. Matrix loss did not increase until after 48 hours postinjury. Furthermore, chondrocyte death was seen early after injury and accelerated to the late time point, day 9, in all manipulations. Conversely, cell stress was found to be greater at 48 hours postinjury, which then declined to the late time point, day 9. CONCLUSIONS AND RELEVANCE: The crushing manipulation followed by shaving and then dicing were the most destructive methods of cartilage manipulation relative to control specimens. Collectively, these outcomes demonstrate the range of injury which occurs with all septal cartilage manipulations and can inform rhinoplasty practice to use the least damaging effective surgical manipulation to obtain the desired outcome. LEVEL OF EVIDENCE: NA.

Background The nasal septal cartilage is often used as a donor graft in rhinoplasty operations but can vary widely in size across the patient population. As such, preoperative estimation of the cartilaginous area is important for patient counseling as well as operating planning. We aim to estimate septal cartilage area by using facial computed tomography (CT) studies. Methods The study was performed using facial CT images taken from 200 patients between January 2012 to July 2015. Using the mid-sagittal image, the boundary of cartilaginous septum was delineated from soft tissue using the mean difference in signal intensity (or brightness). The area within this boundary was calculated. The calculated area for septal cartilage was then compared across age groups and sexes. Results Overall, the mean area of nasal septal cartilage was 8.18 cm2 with the maximum of 12.42 cm2 and the minimum of 4.89 cm2. The cartilage areas were measured to be larger in men than in women (p

To place a collagen membrane containing crushed nasal septal cartilage over the nasal dorsum to see how this graft can improve the results of visible postsurgical irregularities in thin skinned patients.Fifty-seven patients were treated between 2006 and 2010 (26 males and 31 females) whose ages ranged between 31 and 55 years old. They were divided into group a, defect1 mm, group b defect between 1 and 2 mm, group c defect3 mm. These patients presented intraoperative nasal dorsum irregularities that were corrected with 57 cartilage grafts in conjunction with collagen membrane.All of our patients showed an initial over-correction. A dense network of collagen fiber bundles was observed running parallel to the surface of the membrane at the connective tissue-membrane interface. The clinical percentage of volume reabsorption was about 5% after 6 months, measured with clinical pictures and a clinical follow-up. No infection was noted, only 1 patient of dislocation was observed, and 5 patients required some refinements at the long-term follow-up.In the authors' experience the use of bilayered combined cartilage and collagen membrane grafts gives the best aesthetic results with balanced tip projection and dorsum fullness, and avoids thickness and texture modification of the skin above the graft. The use of Bio-gide membrane avoids all problems related to the donor site and shortens surgical time.

The purpose of the study was to analyze the morphological and functional outcomes in a series of 60 patients for whom Type I tympanoplasty was done using alcohol preserved nasal septal cartilage allograft through endoscopic permeatal route. The study was a prospective, interventional (surgical) study of 60 patients between October 2012 and September 2014. Patients were operated using 0°, 4 mm, 18 cm long Hopkin’s rod endoscope through permeatal route. 70% ethyl alcohol preserved allogeneic nasal septal cartilage with thickness of around 0.5 mm was used for grafting. At the end of 6 months, final assessment of morphological outcome i.e. intact tympanic membrane and functional outcome i.e. reduction in Air Bone gap, was done. At the end of 6 months, 57 patients (95%) had intact tympanic membrane. Mean ABG in postoperative patients was 11.83 dB. The operative time taken in 42 patients (70%) was 30–45 min. 42 patients (70%) returned to normal activity in 3–5 days. Endoscopic cartilage tympanoplasty using allogenic nasal septal cartilage can be safely and effectively used for Type I tympanoplasty with good anatomical and audiological results with benefits of reduced operating time, morbidity, pain and ‘No scar’.

Background The nasal septum plays an important role in nasal growth, but there have been few reports on the relationship between the septum and nasal growth. The authors investigated the relationship between septa and external noses using computed tomography during the growth period. Methods One hundred and ninety-eight patients under the age of 21 were enrolled in this study between 2008 and 2012. The authors evaluated a total of 9 measurement items (five for nasal bones and septa, and four for external noses). Results In the final age group, most measurement items were significantly larger in males than in females. However, there was no remarkable difference between male and female growth processes. Nasal bridge length and nasal height were significantly correlated with the nasal bone or septum in almost all age groups. The relative proportion of the cartilaginous septum decreased significantly with age, and was negatively correlated with the perpendicular plate in all age groups. Conclusions Nasal septa and external noses were both larger in males than in females at the beginning of the study period, although not significantly. The differences became significant throughout the study due to differential increases between the sexes during the monitored growth spurts.

Objectives/Hypothesis Electromechanical reshaping (EMR) involves reshaping cartilage by mechanical deformation and delivering electric current to the area around the bend axis, causing local stress relaxation and permanent shape change. The mechanism of EMR is currently unclear, although preliminary studies suggest that voltage and application time are directly related to the concentration and diffusion of acid–base products within the treated tissue with little heat generation. This study aims to characterize local tissue pH changes following EMR and to demonstrate that local tissue pH changes are correlated with tissue damage and shape change. Study Design Ex vivo animal study involving EMR of rabbit nasal septal cartilage and biochemical estimation of tissue pH changes. Methods The magnitude and diffusion of acid–base chemical products in control (0V, 2 minutes), shape change (4V, 4 minutes; 6V, 1, 2, 4 minutes; 8V, 1, 2 minutes), and tissue damage (8V, 4, 5 minutes; 10V, 4, 5 minutes) parameters following EMR are approximated by analyzing local pH changes after pH indicator application. Results There is a direct relationship between total charge transfer and extent of acid–base product diffusion (P

Background: Asians tend to have foreshortened noses with more increased nostril show. In recent years, the nasal septal cartilage has been widely used in caudal septal advancement and nasal tip projection in East Asian. However, a relatively small quantity of less firm nasal cartilage was observed in East Asians compared with Caucasians and very few articles have been found dealing with septal cartilage anatomy of Chinese. Objective: The length, height, area, and thickness of nasal septal cartilage in 10 eastern Chinese were studied to provide anatomic data for the septorhinoplasty or harvesting of cartilage graft. Methods: The septal cartilages in 10 adult cadavers were anatomized and measured for their length, height, area, and thickness. Results: The average length and height of septal cartilage were respectively 2.83±0.47 cm and 2.41±0.39 cm. The average area was 4.94±1.26 cm^2. The average thickness is 0.97±0.15 mm, with the greatest thickness in region b 1.14±0.26 mm, the least thickness in region e (0.83±0.22) mm and region a (0.81±0.27) mm. Conclusion: The findings of this study reinforce the principle of key differences existing in the anatomic data of the septal cartilage between Asians and Caucasians.

Objectives 1) To localize quantitatively the major biochemical constituents of native adult human septal cartilage across whole septa.

Introduction The nasal septum is thought to be a primary growth cartilage for the midface and, as such, has been implicated in syndromes involving midfacial hypoplasia. However, this internal structure is difficult to study directly. The aims of this study were to provide direct, continuous measurements of the growth of the nasal septal cartilage and to compare these with similar measurements of the nasofrontal suture to test whether the growth of the cartilage precedes the growth of the suture and whether the growth of the septal cartilage is constant or episodic. Methods Ten Hanford minipigs were used. Linear displacement transducers were implanted surgically in the septal cartilage and across the nasofrontal suture. Length measurements of the cartilage and suture were recorded telemetrically each minute for several days. Results The growth rate of the nasal septal cartilage (0.07% ± 0.03% length/h) was significantly higher than that of the suture (0.03% ± 0.02% length/h) (P = 0.004). The growth of both structures was episodic with alternating periods of growth (5-6 per day) and periods of stasis or shrinkage. No diurnal variation in growth of the cartilage was detected. Conclusions These results are consistent with the notion that growth of the septal cartilage might drive growth of the nasofrontal suture. Growth of the midface is episodic rather than constant.

To our knowledge, yield strength testing in human nasal septal cartilage has not been reported to date. An understanding of the basic mechanics of the nasal septum may help surgeons decide how much of an L-strut to preserve and how much grafting is needed.To determine the factors correlated with yield strength of the cartilaginous nasal septum and to explore the association between L-strut width and thickness in determining yield strength.In an anatomy laboratory, yield strength of rectangular pieces of fresh cadaver nasal septal cartilage was measured, and regression was performed to identify the factors correlated with yield strength. To measure yield strength in L-shaped models, 4 bonded paper L-struts models were constructed for every possible combination of the width and thickness, for a total of 240 models. Mathematical modeling using the resultant data with trend lines and surface fitting was performed to quantify the associations among L-strut width, thickness, and yield strength. The study dates were November 1, 2015, to April 1, 2016.The factors correlated with nasal cartilage yield strength and the associations among L-strut width, thickness, and yield strength in L-shaped models.Among 95 cartilage pieces from 12 human cadavers (mean [SD] age, 67.7 [12.6] years) and 240 constructed L-strut models, L-strut thickness was the only factor correlated with nasal septal cartilage yield strength (coefficient for thickness, 5.54; 95% CI, 4.08-7.00; P .001), with an adjusted R2 correlation coefficient of 0.37. The mean (SD) yield strength R2 varied with L-strut thickness exponentially (0.93 [0.06]) for set widths, and it varied with L-strut width linearly (0.82 [0.11]) or logarithmically (0.85 [0.17]) for set thicknesses. A 3-dimensional surface model of yield strength with L-strut width and thickness as variables was created using a 2-dimensional gaussian function (adjusted R2 = 0.94). Estimated yield strengths were generated from the model to allow determination of the desired yield strength with different permutations of L-strut width and thickness.In this study of human cadaver nasal septal cartilage, L-strut thickness was significantly associated with yield strength. In a bonded paper L-strut model, L-strut thickness had a more important role in determining yield strength than L-strut width. Surgeons should consider the thickness of potential L-struts when determining the amount of cartilaginous septum to harvest and graft.NA.

Ozet Larengotrakeal rekonstruksiyon (LTR) bas–boyun cerrahlarinin gerceklestirdigi en zorlu prosedurlerden biri olmaya devam etmektedir. Larengotrakeal stenoz (LTS) vakalarinda acik ya da kapali bircok teknik uygulanmaktayken, larengeal tumorlerde tumorun mikrocerrahiyle cikarilmasindan subtotal larenjektomiye kadar bircok konservatif secenek mevcuttur. Ancak bu tip hastalarin tedavisinde tek bir yontem yoktur ve cerrahin uygun hastada uygun metodu uygulamasi gerekmektedir. Bu yazida; cerrahi, travma, tumor ya da larengotrakeal stenoz gibi lezyonlarda /defektlerde kompozit nazal septal kikirdak kullanimi ile ilgili teknik bilgi, endikasyonlar ve deneyimimiz sunulacaktir. Abstract Laryngotracheal reconstruction still remains as one of the most challenging procedures in otolaryngology practice. A variety of reconstruction materials and methods are used to repair laryngotracheal defects. No single surgical procedure exists that is appropriate for all situations, and the surgeon has to make a choice among these methods. This article describes the technical data on, the indications of, and our experience with the use of composite nasal septal cartilage graft for the reconstruction of laryngotracheal defects.

Laser reshaping of nasal septal cartilage is a straightforward, painless, atraumatic, and bloodless approach. It is an office-based or outpatient procedure, not limited by age or most medical comorbid conditions. The laser medical system for laser septochondrocorrection includes an Erbium-doped glass fiber laser, a feedback control system, and particularized surgical instrument. Optimal laser treatment conditions allow achieving the mechanically stable modified nasal septum configurations without damage to the cartilage, perichondrium, and mucosa. Most of the patients operated shown a stable septum straightening and considerable improvement of nose breathing. Clinical results with 5 years of follow up have demonstrated high effectiveness, reliability, and safety of the laser technique.

Study background: Several techniques exist to sculpt nasal septal cartilage grafts for use in functional and cosmetic rhinoplasty, including the use of cold steel, Bovie electrosection and the Sonopet ultrasonic bone aspirator. This is the first investigation on the effects of these disparate tools on gross cellular integrity of sculpted cartilage. Methods: After IRB approval, extraneous nasal septal cartilage harvested during routine septoplasty and/or rhinoplasty procedures was collected from three patients treated within our institution for use in this study. Cartilage specimens from each patient were divided into four equal segments and a partial thickness trough was sculpted in the center of each piece with one of the three techniques described above. One segment remained free of any additional manipulation and served as a comparative control. Gross cellular architecture and number of viable chondrocytes were assessed with optical microscopy. Results: Minimal disruption of the cellular integrity of nasal septal cartilage samples sculpted with each of the three techniques was noted compared to control. Average cell counts revealed 96%, 97%, 97% and 97% viable nuclei in the scalpel, electrocautery, ultrasonic bone aspirator and control groups, respectively. Conclusion: Cartilage sculpting using cold steel, Bovie electrosection and the ultrasonic bone aspirator appear to have minimal effects on cellular integrity of cartilage grafts. This portends a favorable outlook on long term durability of these cartilage grafts and suggests that these three techniques can be used interchangeably for cartilage sculpting needs.

Objectives/Hypothesis: Characterizing the mechanical properties of structural cartilage grafts used in rhinoplasty is valuable because softer engineered tissues are more time- and cost-efficient to manufacture. The aim of this study is to quantitatively identify the threshold mechanical stability (e.g., Young's modulus) of columellar, L-strut, and alar cartilage replacement grafts. Study Design: Descriptive, focus group survey. Methods: Ten mechanical phantoms of identical size (5 × 20 × 2.3 mm) and varying stiffness (0.360 to 0.85 MPa in 0.05 MPa increments) were made from urethane. A focus group of experienced rhinoplasty surgeons (n = 25, 5 to 30 years in practice) were asked to arrange the phantoms in order of increasing stiffness. Then, they were asked to identify the minimum acceptable stiffness that would still result in favorable surgical outcomes for three clinical applications: columellar, L-strut, and lateral crural replacement grafts. Available surgeons were tested again after 1 week to evaluate intra-rater consistency. Results: For each surgeon, the threshold stiffness for each clinical application differed from the threshold values derived by logistic regression by no more than 0.05 MPa (accuracy to within 10%). Specific thresholds were 0.56, 0.59, and 0.49 MPa for columellar, L-strut, and alar grafts, respectively. For comparison, human nasal septal cartilage is approximately 0.8 MPa. Conclusions: There was little inter- and intra-rater variation of the identified threshold values for adequate graft stiffness. The identified threshold values will be useful for the design of tissue-engineered or semisynthetic cartilage grafts for use in structural nasal surgery.

Deficiency of nasal dorsal projection may be inherent or acquired. Repair is most commonly performed with an onlay graft. When nasal septal cartilage is available, it is the author's preferred source for graft material. It is important to realize that dorsal augmentation is an operation performed for aesthetic not functional reasons. As such, patients understandably scrutinize their postoperative result, and attention to detail in all aspects of the surgery is critical in achieving a favorable outcome. The author's technique for using septal cartilage for dorsal augmentation is presented. Specific considerations include patient selection and analysis, graft harvesting, preparation, and placement, donor-site care, and recipient site preparation and postoperative care.

WOS: 000347954400001 PubMed ID: 25569406 Cartilage is commonly grafted during primary and secondary rhinoplasties as a means of addressing both functional and esthetic issues. Generally, such grafts are taken from the nasal septum, but auricular conchae or ribs may serve as donor sites if needed. However, the latter often entail considerable morbidity and graft mismatch. To circumvent these drawbacks, use of implants or processed cartilage (allogenic or xenogenic in origin) has been proposed. Herein, the isogenic transfer of nasal septal cartilage between identical twins is reported.

Background The biomechanical properties of human septal cartilage have yet to be fully defined and thereby limits our ability to compare tissue-engineered constructs to native tissue. In this study, we analyzed the tensile properties of human nasal septal cartilage with respect to axis of tension, age group, and gender. Methods Fifty-five tensile tests were run on human septal specimens obtained from 28 patients. Samples obtained in the vertical and anterior–posterior (both above and within the maxillary crest) axes were subjected to equilibrium and dynamic tensile testing. Results The average values for strength, failure strain, equilibrium modulus and dynamic modulus were not found to be significantly different with respect to axis of tension testing, age group, or gender. Tensile results for septal cartilage were as follows: equilibrium modulus 3.01 ± 0.39 MPa, dynamic modulus 4.99 ± 0.49 MPa, strength 1.90 ± 0.24 MPa, and failure strain 0.35 ± 0.03 mm/mm. Conclusion We confirm that septal cartilage has weaker tensile properties compared to articular cartilage and found no difference in strength with respect to age, gender, or axis of tension (isotropic).

Background The objectives of this pilot study were to (1) determine whether bipolar radiofrequency plasma-mediated ablation (PMA) can efficiently remove nasal septal cartilage and (2) calculate the ablation rate as a function of device power, probe force, and translation velocity using ex vivo porcine tissue. Methods Specimens were secured to a linear translation stage and were subjected to varying translation velocities (4, 7, and 12 cm/s), probe forces (140, 200, and 225 g), and bipolar radiofrequency generator (Coblator ENTec power settings, 38–58, 77–115, and 129–193 Watts root mean squared. Specimen mass loss and depth of ablation were measured using an analytic balance and dissection microscope, respectively. Results Visual and microscopic inspection revealed little char. Mass loss increased with decreasing translation velocity and increasing generator setting. Increasing probe force also influenced mass loss and increased crater depth. Depth of ablation did not correlate with translation velocity or generator setting. Conclusion PMA effectively ablates nasal septal cartilage and may be able to reduce or contour cartilaginous deformities and framework structures in the head and neck.

Surgical reconstruction of an earlobe requires adequate support without sacrificing the delicacy necessary for an attractive result. A two-stage ear lobule reconstruction using a mastoid skin pocket and cartilage from the nasal septum was performed in six patients. The earlobe aesthetics were acceptable and allowed ear piercing. There were no major complications, including no loss of flap, graft extrusion, septal perforation, or infection. Range of follow-up was 1 to 6 years, with an average of 3 years. No revisions have been performed. A two-stage technique for ear lobule reconstruction is described using septal cartilage to preserve shape and definition that has the additional advantage of minimal morbidity.

Background and Objectives: The objective of this study was to quantitatively measure changes in the elastic moduli of rabbit nasal septal cartilage during laser heating. While the efficacy of laser cartilage reshaping has been established for use in nasal surgery, few studies have investigated the temperature-dependent viscoelastic behavior of cartilage. Study Design/Materials and Methods: Cyclic force versus displacement curves were generated during the Nd:YAG laser (l ¼ 1.32 mm, 10 second exposure time, 21.22 W/cm 2 ) irradiation of cartilage specimens secured in cantilevered geometry. Samples were irradiated three times with 30 second cooling intervals between each laser exposure. Measurements were recorded before, during, and after laser irradiation, and then following complete rehydration in normal saline (NS) for 1 hour at 258C. Elastic modulus was calculated assuming linear viscoelastic behavior. Results: The elastic modulus in native tissue decreased during and after successive laser exposures from about 6 to 3.5 MPa. After rehydration, the modulus returned to nearbaseline value. Surface temperature reached a maximum of 658C. Conclusions: The laser irradiation of cartilage using parameters similar to those used in reshaping does not produce significant irreversible changes in the mechanical properties of the tissue. Measurement of the elastic modulus is an effective means of characterizing alterations in cartilage mechanical behavior during and after laser heating. Lasers Surg. Med. 32:377–383, 2003. 2003 Wiley-Liss, Inc.

Cartilage can be shaped by scoring. In an exploratory study in living adult animals, this phenomenon was demonstrated in cartilage of the nasal septum. Bending was observed immediately after superficial scoring of the cartilage surface, and the cartilage always warped in the direction away from the scored side. The scored piece of cartilage still showed its initially distorted shape 10 weeks after primary surgery. In ex vivo experiments, a clear relation between incision depth and bending of septal cartilage was observed. Under these controlled conditions, the variation between different septa was small. Deformation of the septal specimens was increased by introducing single superficial incisions deepening to half the thickness of the cartilage. A positive correlation between incision depth and bending was demonstrated. A model was used to accurately predict the degree of bending of the cartilage after making an incision of a particular depth. Hence, the effect of cartilage scoring can be predicted. Because the results of this controlled study showed excellent reproducibility for different septa, it is expected that this model can be extrapolated to human nasal septum cartilage. This would enable the surgeon to better predict the result of cartilage scoring, either preoperatively or perioperatively.

Background: Nasal septal cartilage is well established as an autograft material. Tissue engineering methods are now being developed to synthesize cartilage constructs with the properties of this type of cartilage. However, important baseline data on the composition of native septal cartilage is sparse. Objectives: To characterize quantitatively the major biochemical constituents of native adult human septal cartilage and determine age- or sex-related variation in composition. Methods: Cartilage was harvested from the inferior region of the nasal septum in 33 patients (mean±SD age, 47.0±13.5 years; range, 24-80 years) during routine septoplasty or septorhinoplasty. Biochemical assays were used to determine the quantities, relative to wet weight, of the major constituents of cartilage: water, collagen (from hydroxyproline), sulfated glycosaminoglycan (sGAG), and chondrocytes (from DNA). Results: On average, each gram of wet cartilage contained 77.7% water, 7.7% collagen, 2.9% sGAG, and 24.9 million cells. Hydration and collagen content showed no significant age variation. Advancing age was associated with a reduction in sGAG content (7.7% per decade, P = .02) and cellularity (7.4% per decade, P = .05). No significant sex differences were found in any of these cartilage constituents. Conclusions: This study represents the first biochemical characterization of the composition of native human septal cartilage. The data serve as a baseline for future comparison of the properties of tissueengineered neocartilage constructs. Furthermore, the age-associated variations in cartilage composition have implications for patient selection for reconstructive procedures.

Four cases of severe subglottic stenosis are reported. The causes of stenosis were long time intubation in two cases, laryngeal injury in one case, and a scar caused by radiation in one case.All cases were treated by two-stage laryngotracheal reconstruction. First, we made a laryngotracheal fissure, and removed the subglottic granulation or scar tissue. After about three month's observation, we reconstructed the anterior tracheal wall with a composite nasal septal cartilage graft (nasal septal cartilage with the unilateral mucoperichondrium) and covered the cartilage with an advanced cervical skin flap, reserving a small stoma for respiration. After three months observation, the stoma was closed in three of four patients. However, in one patient with laryngeal injury the stoma was required for respiration.We consider that a composite nasal septal cartilage graft is suitable for the reconstruction of the anterior tracheal wall in adults because it is easy to obtain the graft, and because the transplantation and reconstruction of the anterior wall of the larynx and trachea with the composite nasal septal cartilage are both safe and relatively simple.

Objective: This study aimed to investigate the biomechanical qualities of the perichondrium and cartilage, and to determine the strength of the septal cartilage against bending forces. Study design: This paper describes an experimental cadaver study. Materials and methods: The nasal septal cartilages of 14 fresh cadavers (8 hours postmortem) were excised from the cadavers and cut into two strips: one with the perichondrium (group A) and one without perichondrium (group B). A bending test was then performed on the strips. Results: The deflection of group A strips was larger than the deflection of group B strips. Flexural strength was also larger in group A strips compared to group B strips. The average modulus of elasticity was 122% higher in group A compared to group B. All conducted tests revealed statistically significant differences between groups. Conclusion: This study objectively shows that the perichondrium provides the cartilage with a 25% bending strength.

Volume Expansion of Tissue Engineered Human Nasal Septal Cartilage Importance: Cartilaginous craniofacial defects range in size and autologous cartilaginous tissue is preferred for repair of these defects. Therefore, it is important to have the ability to produce large size cartilaginous constructs for repair of cartilaginous abnormalities. Objectives: 1. To produce autologous human septal neocartilage constructs substantially larger in size than previously produced constructs 2. To demonstrate that volume expanded neocartilage constructs possess comparable histological and biochemical properties to standard size constructs 3. To show that volume expanded neocartilage constructs retain similar biomechanical properties to standard size constructs. Design: Prospective, basic science. Setting: Laboratory Participants: The study used remnant human septal specimens removed during routine surgery at the University of California, San Diego Medical Center or San Diego Veterans Affairs Medical Center. Cartilage from a total of 8 donors was collected.

Interest in reconstruction and modification of the facial cartilaginous frameworks using advanced technology and instrumentation is growing rapidly. Despite this maturing interest, no animal model has been established to provide morphologic cartilage tissue with similar characteristics to human septum in suitable quantities. The objective of this study was to characterize porcine and lagomorph (rabbit) nasal septal cartilage tissue. Both models share great similarity with their human counterpart and provide a low-cost, high-volume, and easily obtained source of bulk cartilage tissue. We present a technique for harvesting intact septal cartilages from these species, and characterize select cellular, metabolic, and physical properties using pulse-chase radiolabeling, flow cytometry, and mechanical analysis. Our selective evaluation of key tissue properties establishes these species as appropriate animal models for nasal septal cartilaginous surgery.

In the presence of a full-thickness lower eyelid defect too large for reconstruction with a tarsoconjunctival flap alone, the posterior lamella is often reconstructed with a free graft of nasal septal cartilage and mucosa, ear cartilage, or hard palate mucosa. In this series, an alternative approach was taken: a tarsoconjunctival flap of maximum horizontal dimension was created to reconstruct the majority of the posterior lamella defect. A second reconstruction technique, such as a periosteal flap or a Tenzel semicircular flap, was then used to supplement the tarsoconjunctival flap and reconstruct the remainder of the posterior lamella defect. Tarsoconjunctival flap supplementation yielded favorable results in eight patients and is advocated for the reconstruction of large posterior lamella defects too large for reconstruction with a tarsoconjunctival flap alone.

The purpose of this study was to investigate the influence of 3,3-dimethyl-1-phenyltriazene (DMPT) on development of craniofacial structures in mouse fetus. (1) Pregnant C57BL/6 mice were treated with 30 mg/kg DMPT injection on days 10.5 approximately 13.5 of gestation. The fetuses were analyzed on day 15.0. The incidence of micrognathia was formed 100% in the treated group on days 10.5 and 11.0, and then decreased remarkably after day 11.5. This result suggested that the critical period of micrognathic development is days 10.5 approximately 11.0. (2) The fetuses, injected 30 mg/kg DMPT on day 10.5, were sacrificed on days 11.0 approximately 18.0. Their heads were used for the following histomorphological analyses: 1. clearing and Alcian blue-alizarin red double staining and 2. lateral graphic reconstruction using serial frontal sections. Dysmorphology of the anterior portion of Meckel's and nasal septal cartilage became evident after day 13.0, however, nasal capsule cartilage was hardly affected. It was concluded that hypoplastic Meckel's cartilage, caused by the administration of DMPT, induced mandibular dysmorphogenesis.

Objectives:1) Produce autologous human septal neocartilage constructs substantially larger in size than previously produced constructs. 2) Demonstrate that volume expanded neocartilage constructs possess comparable histologic and biochemical properties to standard size constructs. 3) Show that volume expanded neocartilage constructs retain similar biomechanical properties to standard size constructs.Methods:Human septal chondrocytes from 8 donors were used to create 12mm and 24mm neocartilage constructs. These were cultured for a total of 10 weeks. Photo documentation, histologic, biochemical, and biomechanical properties were measured and compared.Results:The 24mm diameter constructs were qualitatively similar to the 12mm constructs. They possessed adequate strength and durability to be manually manipulated. Histologic analysis of the constructs demonstrated similar staining patterns in standard and volume expanded constructs. Proliferation, as measured by DNA content, was similar in 24mm and 12mm constr...