{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T10:41:34Z","timestamp":1791283294864,"version":"4.1.0"},"reference-count":45,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Facial Plast Surg"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>In cases of weak or deficient caudal septum, the caudal septum extension graft (CSEG) is the most commonly used reconstructive method. In the current study we introduce a newly-designed conchal cartilage CSEG and evaluate its cosmetic and functional outcomes. The graft has an average length of 3\u2009\u00b1\u20090.3\u2009cm and composed of a distal double-layered part, which is 3 to 4\u2009mm wide and a proximal single-layered part, which is 1.2 to 1.7\u2009cm wide. The graft design allows the proximal single-layered part to be fixed on either sides of the caudal septum while keeping the distal double-layered segment in the midline. The study included 230 patients, of which 83% were revisions, all patients completed a validated patient-reported outcome measure (PROM) questionnaire pre- and postoperatively. The PROMs used were either the Nasal Obstruction Symptom Evaluation (NOSE) survey or the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS). During the mean follow-up period of 18.2 months (range: 9\u2013192 months) no serious complications were encountered and only six cases (2.3%) required minor revisions of the CSEG.<\/jats:p><jats:p>Using the proposed conchal cartilage, CSEG resulted in an improved cosmetic and functional outcome as evidenced by the significant postoperative improvement in the NOSE, SCHNOS-O, and SCHNOS-C scores with a p-value &lt;0.001, &lt;0.05, and &lt;0.0001, respectively. The graft provided adequate tensile strength and support to the nasal tip, which resulted in improved tip projection, rotation, definition, and symmetry, while maintaining a degree of flexibility and elasticity which is much more than that of the rib or even the septum thus resulting in the most natural feel of the nasal tip lobule.<\/jats:p>","DOI":"10.1055\/s-0042-1760296","type":"journal-article","created":{"date-parts":[[2023,1,11]],"date-time":"2023-01-11T23:55:48Z","timestamp":1673481348000},"page":"408-416","source":"Crossref","is-referenced-by-count":3,"title":["A Novel Ear Cartilage Caudal Septal Extension Graft"],"prefix":"10.1055","volume":"39","author":[{"given":"Hossam M.T.","family":"Foda","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Alexandria Medical School, Alexandria, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3630-0227","authenticated-orcid":false,"given":"Ahmed","family":"El Abany","sequence":"additional","affiliation":[{"name":"Department of Maxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2023,1,11]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1001\/archfaci.9.4.264","article-title":"Defining nasal cartilage elasticity: biomechanical testing of the tripod theory based on a cantilevered model","volume":"9","author":"R W Westreich","year":"2007","journal-title":"Arch Facial Plast Surg"},{"issue":"02","key":"ref2","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1002\/lary.24845","article-title":"Rethinking nasal tip support: a finite element analysis","volume":"125","author":"D Shamouelian","year":"2015","journal-title":"Laryngoscope"},{"issue":"03","key":"ref3","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1001\/archfaci.10.3.152","article-title":"The caudal septum replacement graft","volume":"10","author":"H MT Foda","year":"2008","journal-title":"Arch Facial Plast Surg"},{"issue":"04","key":"ref4","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1097\/00006534-199709001-00026","article-title":"Septal extension grafts: a method of controlling tip projection shape","volume":"100","author":"H S Byrd","year":"1997","journal-title":"Plast Reconstr Surg"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/S1043-1810(05)80008-9","article-title":"Caudal septal extension graft for correction of the retracted columella","volume":"6","author":"D M Toriumi","year":"1995","journal-title":"Oper Tech Otolaryngol\u2013Head Neck Surg"},{"issue":"07","key":"ref6","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1097\/MLG.0b013e31816ed5ad","article-title":"Human nasal cartilage ultrastructure: characteristics and comparison using scanning electron microscopy","volume":"118","author":"P K Holden","year":"2008","journal-title":"Laryngoscope"},{"issue":"01","key":"ref7","doi-asserted-by":"crossref","first-page":"e1610","DOI":"10.1097\/GOX.0000000000001610","article-title":"Structural and mechanical comparison of human ear, alar, and septal cartilage","volume":"6","author":"E J Bos","year":"2018","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"02","key":"ref8","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1097\/00006534-197208000-00008","article-title":"Use of ear cartilage grafts for nasal tip reconstruction","volume":"50","author":"E Falces","year":"1972","journal-title":"Plast Reconstr Surg"},{"issue":"01","key":"ref9","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1007\/BF01572783","article-title":"The bilateral conchal cartilage graft: a new technique in augmentation rhinoplasty","volume":"8","author":"R Muenker","year":"1984","journal-title":"Aesthetic Plast Surg"},{"issue":"06","key":"ref10","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1001\/archotol.1994.01880300067010","article-title":"Nasal reconstruction with conchal cartilage. Correcting valve and lateral nasal collapse","volume":"120","author":"F J Stucker","year":"1994","journal-title":"Arch Otolaryngol Head Neck Surg"},{"issue":"04","key":"ref11","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1097\/00005537-200404000-00007","article-title":"Reconstruction of anterior nasal septum: back-to-back autogenous ear cartilage graft","volume":"114","author":"W Pirsig","year":"2004","journal-title":"Laryngoscope"},{"issue":"06","key":"ref12","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1001\/archfaci.8.6.396","article-title":"Seagull wing graft: a technique for the replacement of lower lateral cartilages","volume":"8","author":"F Pedroza","year":"2006","journal-title":"Arch Facial Plast Surg"},{"issue":"12","key":"ref13","doi-asserted-by":"crossref","first-page":"2092","DOI":"10.1097\/01.mlg.0000149440.20608.7c","article-title":"Auricular cartilage grafts and nasal surgery","volume":"114","author":"G L Murrell","year":"2004","journal-title":"Laryngoscope"},{"issue":"01","key":"ref14","doi-asserted-by":"crossref","first-page":"46","DOI":"10.5999\/aps.2016.43.1.46","article-title":"Sublabial autologous ear cartilage grafting for increasing the nasolabial angle","volume":"43","author":"R Toncic","year":"2016","journal-title":"Arch Plast Surg"},{"issue":"02","key":"ref15","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1097\/SCS.0000000000002380","article-title":"The auricular cartilage in 197 secondary and tertiary rhinoplasties","volume":"27","author":"M Pascali","year":"2016","journal-title":"J Craniofac Surg"},{"issue":"03","key":"ref16","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/j.otohns.2003.12.004","article-title":"Outcomes after nasal septoplasty: results from the Nasal Obstruction Septoplasty Effectiveness (NOSE) study","volume":"130","author":"M G Stewart","year":"2004","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"01","key":"ref17","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1001\/jamafacial.2017.1083","article-title":"The 10-Item Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) for functional and cosmetic rhinoplasty","volume":"20","author":"S P Moubayed","year":"2018","journal-title":"JAMA Facial Plast Surg"},{"issue":"06","key":"ref18","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1258\/002221503321892325","article-title":"External rhinoplasty: a critical analysis of 500 cases","volume":"117","author":"H MT Foda","year":"2003","journal-title":"J Laryngol Otol"},{"issue":"03","key":"ref19","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1002\/lary.24321","article-title":"Nasal tip support: a finite element analysis of the role of the caudal septum during tip depression","volume":"124","author":"C T Manuel","year":"2014","journal-title":"Laryngoscope"},{"issue":"06","key":"ref20","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1001\/jamafacial.2015.1035","article-title":"Quantifying changes in nasal tip support","volume":"17","author":"T J Willson","year":"2015","journal-title":"JAMA Facial Plast Surg"},{"issue":"05","key":"ref21","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1002\/hed.2890080507","article-title":"Cartilage grafts\u2013present status","volume":"8","author":"G H Zalzal","year":"1986","journal-title":"Head Neck Surg"},{"issue":"06","key":"ref22","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1097\/00006534-199711000-00027","article-title":"Nasal cartilage grafts: more than a decade of experience","volume":"100","author":"S S Collawn","year":"1997","journal-title":"Plast Reconstr Surg"},{"issue":"03","key":"ref23","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1046\/j.1365-2273.1998.00133.x","article-title":"Biomaterials in rhinoplasty","volume":"23","author":"H D Vuyk","year":"1998","journal-title":"Clin Otolaryngol Allied Sci"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1097\/00020840-199908000-00008","article-title":"Grafting materials for augmentation septorhinoplasty","volume":"7","author":"D Khurana","year":"1999","journal-title":"Curr Opin Otolaryngol Head Neck Surg"},{"issue":"03","key":"ref25","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1097\/00006534-199903000-00039","article-title":"Use of cartilaginous autografts in nasal surgery: 8 years of experience","volume":"103","author":"L C\u00e1rdenas-Camarena","year":"1999","journal-title":"Plast Reconstr Surg"},{"issue":"04","key":"ref26","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1001\/archotol.126.4.558","article-title":"Grafts in rhinoplasty: alloplastic vs. autogenous","volume":"126","author":"J Parker Porter","year":"2000","journal-title":"Arch Otolaryngol Head Neck Surg"},{"issue":"04","key":"ref27","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1055\/s-2002-36490","article-title":"Structural grafting in rhinoplasty","volume":"18","author":"V C Quatela","year":"2002","journal-title":"Facial Plast Surg"},{"issue":"03","key":"ref28","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1097\/01.sap.0000199153.26947.5e","article-title":"Reconstruction of the nasal dorsum with autologous rib cartilage","volume":"56","author":"V Cervelli","year":"2006","journal-title":"Ann Plast Surg"},{"issue":"04","key":"ref29","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1001\/archotol.126.4.562","article-title":"Autogenous grafts are worth the extra time","volume":"126","author":"D M Toriumi","year":"2000","journal-title":"Arch Otolaryngol Head Neck Surg"},{"issue":"01","key":"ref30","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1097\/00006534-200007000-00033","article-title":"Combined conchal cartilage-ethmoid bone grafts in nasal surgery","volume":"106","author":"B R Neu","year":"2000","journal-title":"Plast Reconstr Surg"},{"issue":"02","key":"ref31","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1288\/00005537-197302000-00001","article-title":"The mature nose","volume":"83","author":"M L Parkes","year":"1973","journal-title":"Laryngoscope"},{"issue":"04","key":"ref32","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1055\/s-2004-815650","article-title":"Rhinoplasty in the aging nose","volume":"19","author":"T Romo III","year":"2003","journal-title":"Facial Plast Surg"},{"issue":"02","key":"ref33","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1097\/01.PRS.0000150145.39509.DB","article-title":"Changing the convexity and concavity of nasal cartilages and cartilage grafts with horizontal mattress sutures: part I. Experimental results","volume":"115","author":"R P Gruber","year":"2005","journal-title":"Plast Reconstr Surg"},{"issue":"02","key":"ref34","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1097\/01.sap.0000112350.53122.50","article-title":"Subtotal reconstruction of the nasal septum using a conchal reshaped graft","volume":"53","author":"A Boccieri","year":"2004","journal-title":"Ann Plast Surg"},{"issue":"04","key":"ref35","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1067\/maj.2002.126749","article-title":"The non-Caucasian nose","volume":"22","author":"G C Peck","year":"2002","journal-title":"Aesthet Surg J"},{"issue":"06","key":"ref36","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1016\/j.asj.2006.10.007","article-title":"Alternative technique for tip support in secondary rhinoplasty","volume":"26","author":"A Echeverry","year":"2006","journal-title":"Aesthet Surg J"},{"issue":"05","key":"ref37","doi-asserted-by":"crossref","first-page":"2287","DOI":"10.1007\/s00266-021-02217-3","article-title":"M-shaped auricular cartilage as modified septal extension graft: a study by three-dimensional anthropometric analysis in Asian rhinoplasty","volume":"45","author":"D Wang","year":"2021","journal-title":"Aesthetic Plast Surg"},{"key":"ref38","doi-asserted-by":"crossref","first-page":"S199","DOI":"10.1097\/SAP.0000000000002638","article-title":"Application of conchal cartilage grafts in nasal tip plasty: comparison and experience of 3 methods","volume":"86","author":"C Zhang","year":"2021","journal-title":"Ann Plast Surg"},{"issue":"05","key":"ref39","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1007\/s00266-014-0373-8","article-title":"Reconstruction of the septum with an autogenous double-layered conchal L-strut","volume":"38","author":"S Haack","year":"2014","journal-title":"Aesthetic Plast Surg"},{"issue":"01","key":"ref40","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1097\/PRS.0000000000003920","article-title":"Septum-based nasal tip plasty: a comparative study between septal extension graft and double-layered conchal cartilage extension graft","volume":"141","author":"Y C Suh","year":"2018","journal-title":"Plast Reconstr Surg"},{"issue":"07","key":"ref41","doi-asserted-by":"crossref","first-page":"NP737","DOI":"10.1093\/asj\/sjab079","article-title":"Folded cymba concha: is it large and stable enough for caudal septal extension graft in Asian rhinoplasty?","volume":"41","author":"S Namgoong","year":"2021","journal-title":"Aesthet Surg J"},{"issue":"02","key":"ref42","doi-asserted-by":"crossref","first-page":"183","DOI":"10.4193\/Rhin17.184","article-title":"Long-term results after restoring nasal tip support using auricular cartilage as an intercrural columellar strut graft: the \u201cI-Beam\u201d technique","volume":"56","author":"E Novoa","year":"2018","journal-title":"Rhinology"},{"issue":"07","key":"ref43","doi-asserted-by":"crossref","first-page":"2109","DOI":"10.1097\/SCS.0000000000002079","article-title":"Comparison of clinical results in nasal tip augmentation either via face to face or back to back technique with autogenous auricular conchal cartilage","volume":"26","author":"M S Sahin","year":"2015","journal-title":"J Craniofac Surg"},{"key":"ref44","doi-asserted-by":"crossref","first-page":"109737","DOI":"10.1016\/j.ijporl.2019.109737","article-title":"The conchal butterfly graft in secondary reconstruction of the bilateral cleft lip nasal deformity","volume":"129","author":"O Jackson","year":"2020","journal-title":"Int J Pediatr Otorhinolaryngol"},{"issue":"11","key":"ref45","doi-asserted-by":"crossref","first-page":"E399","DOI":"10.1002\/lary.26807","article-title":"Age-related histologic and biochemical changes in auricular and septal cartilage","volume":"127","author":"K L Riedler","year":"2017","journal-title":"Laryngoscope"}],"container-title":["Facial Plastic Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0042-1760296.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,21]],"date-time":"2023-07-21T23:12:26Z","timestamp":1689981146000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0042-1760296"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,11]]},"references-count":45,"journal-issue":{"issue":"04","published-online":{"date-parts":[[2023,7,21]]},"published-print":{"date-parts":[[2023,8]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0042-1760296","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0736-6825","1098-8793"],"issn-type":[{"value":"0736-6825","type":"print"},{"value":"1098-8793","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,11]]}}}