[Cartilaginous grafts in primary rhinoplasty]

In staging and performing secondary iatrogenous or post-traumatic rhinoplasty, it has clearly been shown that the use of grafts plays a key role in reconstructing the defective or missing anatomical parts. On the other hand, in primary rhinoplasty, in general the one prevailing concept is removal of the osteo-cartilage to shape the nose. However, in order to achieve a good balance between aesthetics of the various parts of the nasal pyramid and their coherence with the face as a whole, it is often necessary to add at one or more points so that you can remove less elsewhere. In effect, a naturally short nasal tip, unless suitably increased, would require marked removal of the gibbus which could, in turn, throw the nasal pyramid out of proportion with the rest of the face. On the other hand, if the back of the nose is naturally too short, it creates the optical illusion of a tip which is longer than it really is. This also holds true for a tight nose-lip angle or when the portion of the face anterior to the upper jaw is set back, creating the optical illusion of a downward or elongated tip. Integrating the back of the nose, the anterior nasal spine or the canine fossae with a graft makes it possible to achieve more natural results in harmony with the rest of the face. The material of choice for the grafts used by the authors is the quadrangular cartilage of the nasal septum, both autologous and homologous. This material is preserved in a aqueous solution of 10% mertiolate. An alternative can be provided by the cartilage of the auricular concha.