Anatomical reconstruction versus camouflage of the inferior two thirds of the nasal septum

From an anatomical standpoint, the support of the inferior two thirds of the nose is ensured by the cartilaginous septum. Usually, the reconstruction of total loss of the quadrangular cartilage is performed with some success by means of camouflage procedures such as L-shaped struts or cantilever grafts. In this article we report on four patients who presented with severe collapse of the inferior two thirds of the nose. Although the cartilage was completely gone, the septal linings were intact on both sides. An anatomical reconstruction of the quadrangular cartilaginous septum was performed, harvesting a cartilaginous rib graft, carving it to reproduce the septal plate, and suturing it to the nasal spine. The short- and long-term follow-up showed satisfactory aesthetic and functional results, with good height of the nasal profile, adequate tip projection, and patency of the airways. No evidence of similar reports on this particular technique has been found in the literature.