Septal Graft: Graft Harvesting Technique

The Problem

The cornerstone of rhinoplasty is restructuring the nasal framework, and creating a beautiful, stable configuration usually requires cartilage grafting. Nasal septal cartilage is the most commonly used graft source as it is readily available and structurally suitable. Safely harvesting as much septum as possible in one piece maximizes the potential to make the necessary grafts.

The Background

Whether aesthetic or functional, a rhinoplasty involves changing the shape of the nose. A major component of this is utilizing cartilage to fashion grafts that alter the nasal framework and provide structure and support to the neonose. The quadrangular cartilage of the nasal septum is an ideal material as it is sturdy (hyaline cartilage vs elastic auricular cartilage) and readily available (same incision/surgical proximity; avoids donor site morbidity from ear/rib). Furthermore, harvesting septal cartilage can improve the nasal airway if there is a preexisting deviation of the harvested section.

The goal of septal cartilage harvesting is to obtain the largest intact section of cartilage and bone possible while maintaining strong dorsal and caudal septal support. Obtaining a large, unbroken section of cartilage allows the surgeon flexibility in graft design. With the entire harvestable section of cartilage intact on the back table, the surgeon may design optimally shaped grafts utilizing the inherent characters, thicknesses, and curves of the various sections of the septum.