Apoptosis of septal cartilage after bilateral spreader grafts in rhinoplasty.

OBJECTIVE: There are few studies on the ischemic necrosis and apoptosis of septal cartilage after using bilateral spreader grafts in rhinoplasty. We attempted to evaluate structural changes to the septal cartilage after using the bilateral spreader graft and herein propose possible involved mechanisms observed by histopathologic examination, the apoptosis index using the TUNEL assay, and ultrastructural examination using an electron microscope. METHODS: Septal cartilage between bilateral spreader grafts (group A, n = 12), cartilage beside unilateral spreader grafts (group B, n = 12), and normal septal cartilage (group C, n = 12) were obtained from 36 patients who had revision rhinoplasty because of minor cosmetic dissatisfaction. MAIN OUTCOME MEASURES: We investigated the histopathologic appearance via hematoxylin-eosin staining. Then, using the TUNEL assay, we determined the apoptosis index. Finally, we studied cell morphology under a transmission electron microscope. RESULTS: Although the thickness of septal cartilage was not significantly different between groups, the signs of ischemic necrosis were more prominent in group A. The apoptosis index was significantly higher in group A than in group B or C (p < .05). We observed evidence of cellular injury also by electron microscope examination. CONCLUSIONS: The survival of septal cartilage could be affected by bilateral spreader grafts through the mechanism of ischemic necrosis and apoptosis.