Reconstruction of the septum with an autogenous double-layered conchal L-strut

One of the most important preconditions for a straight nose is a straight and stable cartilaginous L-shaped frame with sufficient support for the nasal tip and the cartilaginous dorsum. Where the structure of the septal cartilage is destroyed, a sufficient L-strut must be reconstructed. This article presents a technique for reconstruction of an autogenous L-strut using double-layered conchal cartilages.

A retrospective review was conducted with a subsequent follow-up evaluation 10.5-22 months later. The conchal L-strut was used for 26 patients to reconstruct a new septal frame. The full details of the planning process, L-frame construction, and technical data are described together with two typical cases.

In all 26 cases, the authors were able to reconstruct a sufficient neoseptum. In 25 cases, the neoseptum remained straight. Only in one case did the anterior border deviate immediately after the operation. No slippage from the nasal spine was found. The anchoring to the nasal bones and the upper lateral cartilages was stable. However, one asymmetric columella base was found, caused by an asymmetric support to the footplates by the transplant. The osteocartilagenous vault was successfully reconstructed in all the patients. Of the 26 patients, 25 described a marked improvement in their nasal breathing.

The reported technique enables the surgeon to reconstruct the complete cartilagenous L-frame with both conchal cartilages. For certain cases, this technique of autogenous reconstruction of the nasal septum could be a valuable alternative to reconstruction with rib cartilage.