Shockley, W.

ABSTRACT Objectives Alar reconstruction is common, yet high‐quality outcomes data are limited. This review synthesizes the available literature to guide evidence‐informed reconstructive choices. Methods A systematic review identified 35 eligible studies reporting defect characteristics, techniques, and aesthetic, functional, and graft/flap outcomes. Single‐patient case reports, purely technical papers, and studies without outcome data were excluded. Results Full‐thickness skin grafts (FTSG), FTSG with cartilage, and composite grafts have been used with acceptable aesthetic outcomes for small defects. Local flaps are most common for small to intermediate defects, while regional flaps, particularly melolabial (MLF) and paramedian forehead flaps (PMFF), are the primary options for larger defects. PMFFs have higher reported cosmetic satisfaction but may require more secondary procedures. Conclusions Standard data and evidence reporting for alar subunit reconstruction is very limited, with a predominance of retrospective and technique‐driven studies and gestalt‐based outcomes. Standardized reporting of defect size, functional outcomes, and validated patient‐reported measures is needed. Until higher‐quality data is available, reconstructive decisions should be individualized.

IntroductionNasal valve compromise is a common issue for patients presenting to an otolaryngologist. Anatomically, the dorsal septal cartilage (DSA) articulates with the upper lateral nasal cartilage (ULC). When the ULC weakens, it is prone to collapse and may result in nasal obstruction. Our objectives were to analyze histological differences between quadrangular and DSA nasal cartilages and compare histological composition of these tissues among patients with diagnosis of nasal valve compromise (NVC) versus those without NVC (no NVC).MethodsProspective cross‐sectional study of nasal cartilages from seventy‐three (73) live donors. Quadrangular cartilage (QC), and DSA from patients undergoing septorhinoplasty were collected. Safranin O histochemical staining was used to observe glycosaminoglycans (GAGs) content and cell count. Masson's Trichrome staining was used to assess collagen content in these nasal cartilages.ResultsMean GAG content was lower in DSA compared with QUAD cartilage (68.18% vs. 87.22%, p < 0.0001), and was lowest in DSA of patients with NVC (59.07%). Mean collagen content was higher in DSA compared with QUAD cartilage, (65.43% vs. 46.65%, p = 0.0002), and was highest in DSA of patients with NVC (74.86%).ConclusionThe DSA showed decreased GAG and increased collagen content compared with quadrangular cartilage. Within the DSA subsite, patients with presurgical NVC had the lowest GAG and highest collagen levels. This observation suggests that the biochemical composition of the DSA may contribute to its weakening, potentially resulting in its inability to withstand minor trauma and/or the effects of aging, ultimately leading to NVC.Level of EvidenceN/A Laryngoscope, 134:4252–4258, 2024

ObjectiveAnalyze age‐related changes in histologic features and biochemical properties of human auricular cartilage and two subsites of nasal cartilages (quadrangular cartilage and dorsal septal articulation with upper lateral cartilages).Study DesignProspective cross‐sectional study of nasal and auricular cartilages from seventy‐three (73) live donors.MethodsAuricular cartilage (AC), quadrangular cartilage (QC), and dorsal septal cartilage articulation (DSA) with the upper lateral cartilage (ULCs) were collected intraoperatively. Histochemical staining was used: Safranin O for glycosaminoglycans (GAGs), Verhoeff's for elastin, and Masson's trichrome for collagen. ImageJ2 software was used to calculate cell count and percent stained for each cartilage type. R studio “ggplot” package was used to visualize age versus cell count or percent stained.ResultsParticipant ages ranged from 20 to 77 years, average 46.5 years. There was a significant decline in GAGs with age for the DSA subsite, (n = 64, p < 0.001). Significant increase in collagen content with age was observed for DSA subsite (n = 66, p < 0.001) and the QC subsite (n = 64, p < 0.05). There was a statistically insignificant decline in elastin with age (n = 41, p = 0.309) for AC. Cell count declined with age at all cartilage subsites.ConclusionOur findings confirm that there were age‐related decreases in cartilage glycosaminoglycan content, and chondrocyte cell count in both auricular and nasal cartilages. We have also confirmed that collagen content increases with age for both auricular and nasal cartilage. The histologic findings while not statistically significant in all comparisons, provides additional evidence that there is some loss of structural integrity and flexibility in nasal and auricular cartilage with aging.Level of EvidenceNA Laryngoscope, 134:1220–1226, 2024