Failed septal extension graft in a patient with a history of radiotherapy

Abstract

Background: This report describes the authors’ experience of “melting” septal cartilage after placement of a septalextension graft in a nasopharyngeal cancer patient that had been previously undergone radiation therapy, andprovides a review of the literature. Methods: Electronic medical records were used to obtain details of the patient’s clinical history. Results: A 32-year-old woman, who had previously undergone radiotherapy for nasopharyngeal cancer, visited ourdepartment to for rhinoplasty. Rhinoplasty was performed using a septal extension graft to raise the nasal tip(first operation). Five days after surgery, it was found that the septal extension graft was melting without anysigns of infection, that is, the graft had softened, lost elasticity, thinned, and partially disappeared without anysign of infection at 5 days, and thus, the nasal tip was reconstructed with conchal cartilage (second operation). Fivemonths after surgery, it was found that almost all septal cartilage had disappeared without any sign of infection, andthus, the entire nasal septum was reconstructed using 2-mm costal cartilage and an onlay graft was used for tipaugmentation (third operation). Conclusions: After cartilage has been exposed to radiotherapy, its patency should be viewed with suspicion. Furtherstudies are needed for determine the mechanism responsible for cartilage damage after radiotherapy.