See first-hand how rhinoplasty surgeons harvest ear cartilage for rhinoplasty grafting using a post-auricular incision.
Using a novel, high definition point-of-view camera, Seattle Facial Plastic Surgeon, Dr. Thomas Lamperti, narrates an intra-operative video showing how ear cartilage is harvested to then be used for grafting in rhinoplasty surgery. A post-auricular incision is used to hide the scar behind the ear.
"This is Seattle Facial Plastic Surgeon, Dr. Thomas Lamperti. Today I'm going to show you how we harvest conchal ear cartilage for rhinoplasty. The first step is to place our numbing injection behind the ear where we make the incision. In this case we're using lidocaine with a dilution of epinephrine or adrenaline. The adrenaline is helpful in shrinking down the blood vessels during the procedure so there is less ooziness of blood. The injection also allows us to do what's called hydro-dissection where the injection itself separates some of the tissue off of the cartilage itself.
Next we'll mark the planned incision line behind the ear. You can imagine that this will heal quite well once it's all healed. Next we use a scalpel to make the incision line itself. We dissect carefully through the soft tissue and make our way down to the underlying muscle behind the ear and then the perichondrium -- this is the outer cartilage layer. And as we do our dissection we'll incrementally perform bipolar cautery -- that's what I'm doing now. This seals up the blood vessels. There is a small current of electricity that travels between the tips of the bipolar instrument and this coagulates or cauterizes the vessels. I'll then transition to using scissors to dissect further. You can see where we're able to separate the soft tissue attachments to the cartilage. There are also some muscle attachments. These are the muscles that allow some people to move their ears. We'll then continue to clean off the actual back portion of cartilage from the conceal bowl. The conchal bowl is the curved portion of ear cartilage. We leave most of the ear cartilage alone so the overall shape of the ear essentially stays the same even after surgery. The amount of dissection and the amount of freeing up of tissue depends on how much cartilage is needed to be harvested. In this patient's rhinoplasty quite a bit of cartilage is needed and so we'll pretty widely undermine the skin flaps behind the ear. In this patient's rhinoplasty we are also using septal cartilage but her surgery required more cartilage than her septum would provide which is why we're needing ear cartilage as well.
I'm now outlining visually where I want to make my cut into the cartilage. I'm making this just in front of the anti-helical fold. This helps to maintain the overall shape and structural support of the ear. I incrementally outline the extent where I want to make the incision. Now I want to separate the skin from the cartilage in the front part of the ear. I'm using a Freer elevator for this. If you've seen my other videos this instrument is also commonly used in septoplasty and other nasal surgery. It has a nice dissecting tip which allows us to get under the perichondrium and elevate this off of the cartilage itself. This is a relatively avascular, bloodless plane. We're now very carefully freeing up the edges throughout the planed excision location for the cartilage. We're working your way more superiorly toward the top aspect of the ear to free up that portion of cartilage from the conchal bowl. You can see that quite a bit of cartilage is able to be harvested from the ear if needed. If additional cartilage is required you could also use the other ear. An alternative would be to use rib cartilage instead. Ear cartilage has a certain pre-curved quality in most people being the conchal bowl. It's not quite as strong as septum or rib cartilage, however, so there are limitations depending on the requirements. Again, we're determining the extent of dissection toward the opening of the ear canal. Of course, we don't want to enter the ear canal so we'll stop in front of that. Additionally, we'll extend our dissection toward the upper part of the ear as well. You can see that I'm as far as I need to go in that aspect as well. Once I'm happy with the undermining of the extent of soft tissue I'll use a scalpel again to make our last cut towards the front. And this will finally free up all of the attachments of the cartilage from the ear. We'll carefully work our way around where we've undermined the soft tissue and perichondrium. We're now making our final cut to carefully free up the skin and soft tissue toward the bottom of the graft itself. I'm now using scissors to cut the last attachments and we'll have a freed up ear cartilage graft. You can see that it is quite extensive and can be quite useful for a variety of uses in rhinoplasty. We'll put it over on the back table and store it in some salt water. Lastly, we'll close the incision line and re-appose the skin flaps with dissolvable sutures."
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