Dott. Armando Boccieri

Reconstructive rhinoplasty often entails the use of grafts for structural deficiencies caused by malformation, trauma or previous operations.
Despite the positive results found in the most recent literature for certain alloplastic grafts, the major case studies all recognize the complete reliability of cartilage grafts in rebuilding the nasal pyramid. Such grafts are in fact known to be easy to shape as well as resistant to infection and resorption. Cartilage from the nasal septum, the ear and the rib can all be used in that order of preference. In the case of reconstructive rhinoplasty, however, septal cartilage is often not available or insufficient to fill all the gaps. At the same time, the use of rib cartilage can prove more complex and presents greater possibility of discomfort in the donor region. The use of grafts of auricular cartilage, mostly from the concha, has thus become increasingly popular with surgeons in recent years. Ease of removal, the absolute absence of deformity and visible scars in the donor region, and the large amount of tissue available are unquestionably the fundamental reasons for this preference. The auricular concha can be harvested on both sides, is easy to shape, and can provide grafts for reconstruction of the various anatomical subunits of the nasal pyramid.

The removal of cartilage from the concha can be carried out by means of a retroauricular incision so as to leave no visible mark. It should be stressed that painstaking preoperative analysis of the patient’s structural deficiencies is essential in every case of nasal reconstruction. This analysis can become still more precise during an operation using the open approach, which makes the problems involved directly visible. The harvesting of auricular cartilage should be carried out in this perspective with a view to precise reconstruction of the missing or weakened anatomical structures.

Left: the ear before removal. Centre: the boundaries of the piece of cartilage to be removed. Right: after removal. The ear remains absolutely identical.

For further details, readers are referred to my article ‘The Conchal Cartilage Graft in Nasal Reconstruction’, Journal of Plastic Reconstructive Aesthetic Surgery, 2007, 60(2), pp. 188–94.