Reply: Primary Septal Cartilage Graft for the Unilateral Cleft Rhinoplasty
The inquiring authors also raised the concern of harvesting a 0.5 × 2-cm septal cartilage from the caudal portion of the nasal septum with regard to facial growth. They commented that a 0.5 × 2-cm septal cartilage rim graft was insufficient in size to support the nostril shape when these patients reach adulthood. The use of a primary septal cartilage rim graft was to provide better nasal symmetry and aesthetic as they grow throughout childhood and early adolescence. Whether these patients need secondary cheiloplasty or rhinoplasty as they reach adulthood is still unknown. Although a septal cartilage graft is unlikely to proliferate after being transplanted to the recipient site, cartilage graft has been shown to remain viable with minimal graft resorption based on histologic findings reported by several studies.
With regard to the donor-site defect, we performed a limited subperichondrial dissection at the caudal aspect of the septal cartilage at the time of graft harvesting. The perichondrium surrounding the donor site remains intact. Whether the donor-site defect fills in with chondral matrix that eventually matures into cartilage is still unknown. This certainly warrants a separate investigation by computed tomographic or magnetic resonance imaging studies when we follow these patients long term to evaluate their facial growth and surgical outcomes.