Optimizing the Septal Donor Site in Asian Rhinoplasty: A Computed Tomography-Based Simulation of the...

Asian rhinoplasty frequently requires robust structural support to counteract a thick skin envelope. However, relying solely on septal cartilage often leads to graft depletion after preserving a safety L-strut. This study quantifies the volumetric sufficiency of the composite bony-cartilaginous unit to address this limitation while ensuring skull base safety.

A retrospective computed tomography analysis was performed on 116 Asian adults (60 men, 56 women). A standardized harvest template was virtually executed, assuming the preservation of a 10-mm L-strut. Total septal area, harvestable cartilage, and the composite bony-cartilaginous unit (cartilage, perpendicular plate of the ethmoid, and vomer) were quantified using defined anatomical landmarks.

The harvestable septal cartilage averaged 461.5 mm², which was significantly smaller in women than in men (p < 0.001). Expanding the harvest to include the bony septum yielded a composite area of 992.0 mm², representing a 2.21-fold increase in graft availability. Radiographic analysis established critical safety landmarks: the mean skull base angle was 123.6°, the distance from the anterior nasal spine to the cribriform plate was 48.9 mm, and the distance to the anterior sphenoid wall was 54.3 mm.

Septal cartilage is an inherently scarce resource in Asian rhinoplasty, particularly in females. Harvesting the septum as a bony-cartilaginous unit safely and reliably doubles the graft supply. With precise osteotomy trajectories, this composite graft eliminates the need for distant donor site morbidity, serving as an optimal local reserve.

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