Figure 4. Chonchal cartilage autograft used to recontour a distorted nose. Photographs shown are preoperative (A) and 2 years postoperatively (B).

Case 1 is an example of the long-term survival of a septal cartilage autograft. It was inserted in 1971 through an endonasal approach to correct a polly beak deformity and depressed nasal tip. The graft extends the length of the columella and lobule and projects the tip (Fig. 1, A and B). This graft appears to he essentially unchanged after 16 years as can he seen in photographs taken preoperatively (Fig. 1A) and 1 (Fig. 1B) and 16 (Fig. 1C) years postoperatively.

Merthiolate-preserved homografts have been used extensively in the past. The ready availability of banked cartilage was a great convenience to the nasal surgeon. Case 2 is a typical example of a septal cartilage homograft stored in Merthiolate and inserted as a columella strut (Fig. 2A) for tip projection in 1977 (Fig. 2B). The postoperative photograph was taken at 6 months, and the most recent photograph was taken in August 1987. There has obviously been no loss of tip support (Fig. 2C).

Previously, nasal dorsal augmentation was achieved using layered strips of septal cartilage (autografts or homografts) or conchal cartilage autografts. Results of contour restoration with these grafts were generally satisfactory. The availability of irradiated rib cartilage has markedly improved the ability of the surgeon to contour the nose in some patients. It has been most helpful for rhinoplasty in non-Caucasian patients, saddle nose deformities of traumatic or congenital etiology, and revision rhinoplasty. In some cases of dorsal depression combined with tip ptosis and when septal cartilage is unavailable, irradiated rib has proved invaluable. Case 3 shows the use of' an irradiated cartilage homografts inserted through an external approach to recontour a marked congenital saddle nose deformity (Fig. 3. A-D). Irradiated rib homografts (realizing there is a question of 10-year survival) are used in those patients in whom comparable results cannot he achieved with an available autograft.

Case 4 is an example of' the use of multiple small chonchal cartilage autografts appropriately placed to recontour a distorted nose after prior surgery (Fig. 4, A and B). The concha and the thin portion of the nasal septum are excellent sources for these grafts.

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