The Role of Septal Cartilage in Rhinoplasty: Cadaveric Analysis and Assessment of Graft Selection

Background: In addition to providing nearly 50% of total airway resistance via the internal valve, the nasal septum provides support for the cartilaginous portion of the nasal dorsum, and it is responsible for determining the projection of the nasal tip. In modern rhinoplasty, septal cartilage plays an important role as a donor graft material. Objectives: The authors evaluate the anatomy of nasal septal cartilage, identifying variations according to certain regions of the septum and proposing a correlation between the topography and morphology of septal cartilage and graft choice. Methods: An anatomical study was performed on 14 fresh adult cadavers. The excised septal cartilage was placed on grid paper; digital images were taken; all septal cartilage was divided into nine equivalent quadrants; and quantitative measurements for length, height, and area were calculated and compared. Statistical significance was set at P < .05. Results: The average length of the septum was 35.14 mm, while the average height was 32.5 mm. The average septal area was 933.11 mm2. The septal thickness mean values were analyzed in nine quadrants, ranging from 1.04 to 1.71 mm. Statistically-significant differences in mean values were found in 13 of the 14 cadavers. Specifically, the central and cranial areas were thickest, and the area corresponding to the L-strut was thinnest. Conclusions: Anatomical variations of the thickness of septal cartilage excisions were found to be statistically significant, and these differences play an important role in the proper selection of the septal grafts.