Biochemical Composition of the Dorsal Septal Cartilage May Contribute to Weakening and Ultimate Nasal Valve Compromise

by Linda Kossoff •

CLINICAL QUESTION

What are the histological differences between quadrangular cartilages (QC) and dorsal septal cartilages (DSA), and how do the histological compositions of these tissues compare among patients with diagnosis of nasal valve compromise (NVC) versus those without NVC?

BOTTOM LINE

Findings suggest that the biochemical composition of the DSA varies among individuals and may contribute to its weakening.

BACKGROUND: Many functional rhinoplasty techniques are designed to address stenotic or dynamically collapsed internal nasal valves. These techniques can improve form and function, but variable underlying anatomy and changes with aging create a challenge. There is limited understanding of the factors causing dysfunction in the structural integrity of the nose.

STUDY DESIGN: Prospective cross-sectional study

SETTING: University of North Carolina School of Medicine, Chapel Hill, N.C.

SYNOPSIS: Researchers intra-operatively collected excess nasal cartilage tissues from patients undergoing septorhinoplasty with butterfly graft (n=42) and patients undergoing septorhinoplasty without butterfly graft replacement (n=31). As not all 73 participants had surplus DSA cartilage available, 64 specimens were collected. Stains used to observe glycosaminoglycans (GAGs) content, cell count, and collagen content in these nasal cartilages revealed a significantly lower GAG content in DSA compared with QC (68.18% versus 87.22%). Moreover, GAG content was lowest in DSA of patients with NVC (59.07%). Mean collagen content was higher in DSA compared with QC (65.43% versus 46.65%) and highest in DSA of patients with NVC (74.86%). There was no difference in chondrocyte cell count between the subsites. Authors emphasize that the DSA is the functionally critical subsite where the dorsal septum articulates with the upper lateral cartilages and must provide resistance to the transluminal pressure differences during nasal respiration over a patient’s lifetime. Thus, the reduction in GAG content found in the DSA in patients diagnosed with NVC may contribute to clinical findings of palpable weakness of mid-vault support due to diminished stiffness, resilience, and durability. Study limitations included a lack of racial diversity in samples.

CITATION: Kim SG, et al. Biochemical variability of nasal cartilages: implications in functional rhinoplasty. Laryngoscope. 2024;134(10):4252-4258. doi: 10.1002/lary.31480.