Abstract
Objective Reconstruction of a weakened septal cartilage is a key procedure for the correction
of deformed noses. However, when septal mucoperichondrium dissection is technically
challenging, reconstruction of the lower two-thirds of the nose should be performed
bypassing the damaged septal cartilage and mucosa. This article summarizes our experience
with treating patients with severely damaged septal cartilage with bypass L-strut
graft using costal cartilage.
Methods We retrospectively reviewed 26 patients who underwent rhinoplasty using bypass L-strut
graft. Autologous costal cartilage was used for creating L-strut in two different
ways: (1) by fashioning the L-shaped graft as one unit using the sixth rib cartilage
and (2) by integrating a dorsal strut with a columellar strut using slices of the
seventh rib cartilage. The caudal strut is fixated to the anterior nasal spine; the
dorsal L-strut is placed on the nasal dorsum with no fixation to the nasal bone. Medical
records were assessed for demographic, clinical, and treatment information.
Results One-piece-type L-strut graft was used for 11 patients and integrated-type L-strut
graft was used for 15 patients. No statistical differences were found in postoperative
aesthetic outcomes between the two groups. The postoperative assessment of surgical
outcomes was excellent in 10 patients, good in 10, fair in 6, and poor in none. Functionally,
all 26 patients experienced improvements in nasal breathing.
Conclusion Bypass L-strut graft using costal cartilage is a useful surgical maneuver of septal
reconstruction in particular nasal deformity when the creation of the septal mucoperichondrial
pocket is difficult or better to be avoided.
Keywords augmentation rhinoplasty - L-shaped implants - costal cartilage grafts - septal cartilage
damage - nasal deformity
