TEMPORALIS FASCIA GRAFTS IN OPEN SECONDARY RHINOPLASTY

Parchment thin skin is a common problem associated with secondary rhin oplasty. When such skin is present, the underlying osseocartilaginous skeleton often becomes visible. Although many techniques have been use d to treat the condition, we have found that an onlay graft of tempora lis fascia is a most satisfactory method to cover the underlying osseo cartilaginous framework or cartilage grafts. Temporalis fascia grafts have been advocated for this purpose in closed rhinoplasty; however, p recise placement of the graft is difficult because the graft rolls. On the other hand, when used in open rhinoplasty, the graft may be place d accurately and secured under direct vision. This paper presents our experience with temporalis fascia grafts in open secondary rhinoplasti es. Six female patients ages 31 to 57 underwent open secondary rhinopl asty. Five patients also had autologous cartilage grafts. Our average follow-up was 24 months; the minimum was 1 year, and the longest 7 yea rs. All patients had excellent dorsal contours and osseocartilaginous irregularities were not observed. One patient developed a culture-prov en nasal infection that responded successfully to antibiotics without removal of the fascia or cartilage graft, a result unlikely to occur w hen alloplastic materials are used. Biopsy of the temporalis fascia an d cartilage grafts was obtained in one patient 12 months after placeme nt. Microscopic examination confirms the long term viability of both g rafted tissues, inasmuch as the temporalis fascia was vascularized and normal chondrocytes were present in the cartilage grafts. In summary, we have found that temporalis fascia grafts are a very satisfactory m ethod for managing thin skin in open secondary rhinoplasty.