Posterior prolongation of the cartilaginous nasal septum: an under-utilised source of autologous graft material P S PHILLIPS 1 , R J HARVEY 1 , R SACKS 2 , D CHIN 1 , G N MARCELLS 3 Departments of Otolaryngology, 1 St Vincent’s Hospital, Sydney, 2 Concord General Hospital, Sydney, and 3 Sydney Hospital, New South Wales, Australia Abstract Aim: To assess the clinical and radiological characteristics of the posterior prolongation of the cartilaginous nasal septum, an under-utilised source of autologous cartilage for nasal reconstruction. Materials and methods: Consecutive patients undergoing primary, external approach rhinoplasty were included. The septal cartilage was assessed intra-operatively prior to routine harvest. Cartilage use was recorded and post- operative cosmesis noted. Computed tomography scans from a separate patient group, with no septal surgery, were used to assess septal cartilage dimensions. Results: Of the 25 rhinoplasty patients studied, 24 had harvestable septal cartilage, with a posterior prolongation mean length ± standard deviation of 24.3 ± 8.40 mm, mean height of 4.33 ± 0.34 mm and mean width of 1.1 ± 0.35 mm. The mean post-operative cosmesis score was +2.41 ± 0.71 at a mean follow up of 45 ± 8.7 weeks. All 25 radiology patients had visible posterior prolongations on computed tomography (mean length, 18.1 ± 5.1 mm; mean height, 4.2 ± 1.1 mm; mean width 1.5 ± 0.63 mm). Conclusion: Harvesting of the posterior prolongation would increase by 25 per cent the cartilage area available for autologous grafts. Endoscopic guidance aids this process. Cartilage is most commonly used for overlay grafts, with good cosmesis. The posterior prolongation is demonstrated on computed tomography, although dimensions may be underestimated. Key words: Posterior Prolongation; Rhinoplasty; Graft; Cartilage; Sphenoidal Process Introduction Cosmetic and functional nasal surgery requires a detailed knowledge of the anatomy of nasal structures, in order to plan the most effective strategies for chan- ging those structures. Autologous nasal septal grafts are often believed to be the most successful material for nasal reconstruction during external rhinoplasty. 1 Although artificial materials such as Medpor ® have been used, they have been associated with a higher incidence of short- and long-term complications, including extrusion when placed in areas with thin overlying skin. 2 Traditional representations of the nasal septal cartilage commonly portray it as having a quadrilateral shape – indeed, this cartilage is also known as the quadrilateral cartilage. However, the true shape of this cartilage includes a posterior ‘tail’ of cartilage which lies between the vomer and the per- pendicular plate of the ethmoid (Figure 1). 3 This pos- terior prolongation of cartilage has been described in some anatomical texts as the ‘sphenoidal process’ of the nasal cartilage. 4,5 This area has the potential to provide extra cartilage in surgical cases requiring reconstruction or augmentation of nasal structures. Structured rhinoplasty procedures involve substan- tial reconstruction of the nasal cartilage skeleton. Additional cartilage may be needed for spreader grafts or a columella strut. Further cartilage may be required to provide onlay grafts to achieve the desired nasal shape. Even in primary rhinoplasties, the avail- ability of cartilage may be scarce, and all possible sources of cartilage from the nasal septum must be har- vested in these cases if the use of cartilage from other sites (e.g. conchal or costal) is to be limited. Previously, we had noted the posterior prolongation of the nasal septum to be consistently present in surgi- cal cases, and had found it a useful material for nasal reconstruction. However, we found no work document- ing the presence, characteristics and possible uses of the posterior prolongation area of the septal cartilage in a clinical setting. We therefore set out to Accepted for publication 25 July 2012 First published online 9 October 2012 The Journal of Laryngology & Otology (2013), 127 (Suppl. S1), S21–S25. MAIN ARTICLE © JLO (1984) Limited, 2012 doi:10.1017/S0022215112002253