Anatomical characteristics of the conchal cartilage with suggested clinical applications in rhinoplasty surgery.

BACKGROUND: Numerous cartilage grafts from a number of donor sites have been described, each with a different shape and size. These donor sites include the nasal septum, costal chondral cartilage, and the conchal bowl. Although harvests from the conchal bowl are commonly-employed, the techniques have been minimally-described in the literature, particularly as it applies to rhinoplasty. OBJECTIVES: The authors identify differences in the conchal bowl cartilage parameters that could aid in the planning and harvesting of conchal grafts during augmentation rhinoplasty. METHODS: The authors dissected ears from fourteen cadavers (eight females and six males), ranging between 59 and 77 years of age. The conchal bowls were isolated, after which a reference point or was marked at the junction of the helical root and the conchal extension of the helical root. A cartilage grid was mapped out at 3-mm interval divisions with a horizontal limb axis parallel to the helical root extension and a vertical limb axis perpendicular to the latter. Conchal cartilage width, height, and thickness were then measured. Axial tissue slices were harvested and histologic preparations completed with hemotoxylin and eosin (H&E) staining to delineate microscopic characteristics of the cartilage. RESULTS: Maximum conchal bowl width ranged from 1.9 to 2.9 cm and was widest on average over the cymba (2.4 ± 0.3 cm). Maximum conchal bowl height ranged from 1.7 to 3.1 cm and was greatest on average over the region posterior to the junction of the helical root and conchal bowl (2.4 ± 0.5 cm). Conchal bowl thickness ranged from 1.9 to 4.4 mm and was observed thickest over both the conchal extension of the helical root (3.5 ± 0.4 mm) as well as over a distinct region in the inferior-anterior aspect of the cavum (3.7 ± 0.9 mm). No difference in thickness was observed between the conchal extension of the helical root (3.5 ± 0.4 mm) and the distinct region in the inferioranterior aspect of the cavum (3.7 ± 0.9 mm; P > .05). Naturally-occurring cartilaginous divisions were appreciated on histologic specimens located at the junction of the cavum and external auditory meatus and at the junction of the helical root and conchal extension of the helical root. CONCLUSIONS: The results, examination, and outline of conchal bowl parameters from cadaver cartilage demonstrated in this article will aid the surgeon in effectively obtaining the appropriate cartilage grafts for placement during rhinoplasty.

The effect of excess weight gain in teenage pregnancies.

Excess weight gain in pregnancy, as defined by the Institute of Medicine (IOM), has been linked to adverse obstetrical outcomes. However, this relationship has not been examined in the younger maternal population. Our aim was to study excess weight gain in our inner-city teenage population. In this retrospective cohort study, we reviewed all nulliparous teenage deliveries between 2000 and 2004. The groups were divided by IOM criteria into "underweight" (body mass index [BMI] <20 kg/m(2); n = 58), "normal" (BMI, 20 to 26.0 kg/m(2); n = 255), "overweight" (BMI, 26.1 to 29.0 kg/m(2); n = 54), and "obese" (BMI > 29.0 kg/m(2); n = 89). The groups were then compared according to normal (control, n = 257) and excess weight gain (n = 199). Frequencies and odds ratios (ORs) for adverse outcomes were calculated. Excess weight gain was associated with an increased risk for cesarean delivery (OR 1.96, 95% confidence interval [CI], 1.28 to 3.01) and postpartum fever (OR, 2.46; 95% CI, 1.13 to 5.35). Significant neonatal findings included higher birthweight (3199 g versus 2864 g; p < 0.0001) and increased risk of macrosomia (OR, 8.18; 95% CI, 2.02 to 32.99) in the excess weight gain group. We concluded that excess weight gain places teen mothers at increased risk for cesarean delivery, postpartum febrile morbidity, and macrosomia. Interventions aimed at optimal weight gain in teen pregnancies are warranted.

Septal cartilage defined: implications for nasal dynamics and rhinoplasty.

BACKGROUND: Although the septal cartilage is integral to structural nasal stability, it is routinely violated during septorhinoplasty. This occurs during dorsal hump reduction, caudal septal reduction, submucoperichondrial resection of a deviated septum, or harvesting of cartilage graft material. Despite such routine alteration and/or use, the characteristics of septal cartilage have not been adequately defined. METHODS: By measuring septal length, height, and cartilage thickness mapped out at 5-mm intervals over the entire nasal septum in 11 fresh cadaver specimens, the characteristics of septal cartilage were determined. RESULTS: Septal thickness measurements demonstrated significant differences along the nasal septum, with the greatest thickness along the septal base (2.7 +/- 0.1 mm), followed by intermediate thickness along the septal dorsum (2.0 +/- 0.2 mm) and the least thickness along the central portion (1.3 +/- 0.2 mm) and at the anterior septal angle (1.2 +/- 0.1 mm) (p < 0.001). CONCLUSIONS: These observations clarify several nuances regarding septal structural stability, septal deformities, and the effects of septal alteration during rhinoplasty. The findings of this study reinforce several principles, including recognition of factors contributing to the high propensity of acquired central septal perforations; preservation of a generous L-strut width, especially at the anterior septal angle, or if planning dorsal hump reduction, prudent allocation of harvested septal cartilage; and clarifying the proclivity for supratip deformity following rhinoplasty.