The Use of Posterior Auricular Fascia Graft (PAFG) for Slight Dorsal Augmentation and Irregular Dorsum Coverage in Primary and Revision Rhinoplasty: A Prospective Study

Abstract

Introduction: Augmentation and coverage of irregularities of the nasal dorsum remain a challenge in rhinoplasty. Different techniques have been described in the current literature for this purpose. The aim of this study is to assess and illustrate the author experience and outcomes using the posterior auricular fascia graft (PAFG) for dorsal camouflage and augmentation in primary and revision rhinoplasty.

Material and methods: A prospective bicentric study was conducted, including patients with slight dorsal deficiencies and/or with dorsal irregularities following hump resection, trauma or previous rhinoplasty receiving PAFG to improve the rhinoplasty outcome. To objectively assess the graft resorption rate, MRI was performed 2 weeks and 18 months after surgery. To investigate patient satisfaction, the preoperative and 1-year postoperative scores obtained using the rhinoplasty outcomes evaluation (ROE) scale were compared. The scores following a normal distribution obtained for each patient were compared using a paired t-test.

Results: Forty-five patients were enroled in this study. Average follow-up duration was 35.4 months. Patients' age ranged from 17 to 57 years. No cases of infection or major graft resorption were observed. No postoperative scars were visible at the donor site. All patients were satisfied after surgery, and a statistically significant difference between pre- and postoperative scores (p<0.0001) was observed.

Conclusion: This study showed that PAFG is a reliable technique for dorsal camouflage and slight augmentation in primary and revision rhinoplasty. The procedure is safe, easy and quick and only requires a small learning curve.

Level of evidence ii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Keywords: Irregular dorsum coverage; Nasal dorsal augmentation; Patient satisfaction; Posterior auricular fascia; Rhinoplasty; Rhinoplasty outcomes evaluation scale.

Fig. 1

Cadaver dissection showing intrinsic postauricular fascia (IPF) and the thicker extrinsic postauricular fascia (EPF) continuous with the mastoid area. Auricular fascial incisura demarks the limits between IPF and EPF and corresponds with the surface anatomy of the auriculo-cephalic sulcus

Fig. 2

Schematic representation of the PAFG positioning

Fig. 3

This image depicts the intraoperative appearance of the posterior auricular fascia graft, which measured 5 mm in thickness in this particular case. In our study, the mean thickness of the postauricular fascia was found to be 3.5 ±2.7 mm (range of 3.5-6.2 mm). These findings suggest that the thickness of the PAFG may vary among individuals and should be carefully considered during surgical planning.

Fig. 4

Example of a 2-week postoperative MRI a. The fascia construct maintains its volume and shape throughout the postoperative period and as confirmed by the 18 months postoperative MRI b, no major graft resorption occurred in our series

Fig. 5

Preoperative appearance of a 20-year-old girl a-c. The patient immediately after birth had a nasal catheter inserted, which caused adhesion of the left soft triangle with collapse of the external nasal valve. She approached us because she wanted a slight lowering of the nasal tip, correction of a mild dorsal irregularity and correction of the collapse of the left external nasal valve. The patient underwent open rhinoplasty. A septal extension graft taken from the nasal septum was used to slightly rotate the nasal tip downward. Postauricular fascia was employed to correct the mild dorsal irregularity, and the same retroauricular incision used for harvesting the fascia was used to harvest a conchal cartilage graft to correct the collapse of the left external nasal valve. Residual nasal mucosa excess at the end of the procedure was used to correct the iatrogenic adhesion of the left soft triangle. The patient was highly satisfied with the achieved result d-f. The postauricular scar was well hidden and did not cause any problems for the patient g

Fig. 6

Preoperative photographs of a 28-year-old woman who underwent primary aesthetic and functional rhinoplasty using an open approach a-d. The procedure included tip reshaping with the use of a septal extension graft and intradomal sutures. The postauricular fascia graft (PAFG) was used to address the remaining irregularities on the nasal dorsum after the removal of the osteo-cartilaginous hump. During the 1-year follow-up, the patient expressed high satisfaction with the outcome and reported no irregularities on the nasal dorsum e-h