Gadaleta, Dominick

Heffelfinger, Ryan N.

English

Jefferson Digital Commons

Thomas Jefferson UniversityJefferson Digital CommonsDepartment of Otolaryngology - Head and NeckSurgery Faculty PapersDepartment of Otolaryngology - Head and NeckSurgery3-2019Application of Tasman technique for congenitalabsence of nasal cartilage: A case reportDominick GadaletaThomas Jefferson University, dominick.gadaleta@jefferson.eduRyan N. HeffelfingerThomas Jefferson University, Ryan.Heffelfinger@jefferson.eduLet us know how access to this document benefits youFollow this and additional works at: https://jdc.jefferson.edu/otofpPart of the Otolaryngology CommonsThis Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of ThomasJefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarlypublications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers andinterested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion inDepartment of Otolaryngology - Head and Neck Surgery Faculty Papers by an authorized administrator of the Jefferson Digital Commons. For moreinformation, please contact: JeffersonDigitalCommons@jefferson.edu.Recommended CitationGadaleta, Dominick and Heffelfinger, Ryan N., "Application of Tasman technique for congenitalabsence of nasal cartilage: A case report" (2019). Department of Otolaryngology - Head and NeckSurgery Faculty Papers. Paper 40.https://jdc.jefferson.edu/otofp/40Contents lists available at ScienceDirectOtolaryngology Case Reportsjournal homepage: www.elsevier.com/locate/xocrApplication of Tasman technique for congenital absence of nasal cartilage: Acase reportDominick Gadaleta∗, Ryan HeﬀelﬁngerThomas Jeﬀerson University Hospital, Department of Otolaryngology, H&N Surgery, 925 Chestnut St, 6th Floor, Philadelphia, PA, 19107, USAA R T I C L E I N F OKeywords:RhinoplastyCartilageFunctionalTasmanTechniqueIntroductionCongenital absence of nasal cartilage is a rare phenomenon that cantake place in isolation or as part of a syndrome, including Apert, Fraser,and Binder Syndromes. Embryologically, the nose begins its develop-ment during the 4th week of gestation with the migration of the nasalplacodes. Speciﬁcally, the nasal septum begins its development duringweek 5, however, it is not until the 10th week that the primitive tissuesbegin their diﬀerentiation into cartilage and bone. The absence of thesestructures can have a devastating eﬀect on both aesthetic and functionof the nose.The Tasman technique has been described previously and success-fully applied to rhinoplasties that require substantial dorsum augmen-tation [1,2]. The procedure involves creating a dorsal onlay graft usingdiced cartilage and tissue sealant. Although sparse, current literaturedescribing the technique does report satisfactory cosmetic results andlow resorption rates up to 9 months postoperatively [2].This technique can be customized in patients requiring both smalland large dorsal reconstructions, such as saddle-nose deformity. In thiscase report, we describe employing the Tasman technique to re-construct the nose of a patient with congenital absence of nasal carti-lages.Case reportThis is a 17-year-old female who presented to the clinic for eva-luation of her nasal deformity. She expressed diﬃculty with nasalbreathing. She had no signiﬁcant medical or surgical history. She de-nied medications and allergies. She had a short history of smokingtobacco and marijuana but denied alcohol use. Of interest, the patientdid report that her biological mother used both alcohol and illicit drugsduring the time of pregnancy.Fig. 1 shows the patient preoperatively. Preoperative CT of the si-nuses revealed absent nasal cartilages, hypoplastic nasal bones, and areduced nasal aperture. Her maxillary sinuses were well developed andwell aerated. The patient was taken to the operating room for func-tional rhinoplasty with nasal dorsum repair via the Tasman technique.IRB approval for this study was waived on the basis of this being acase report with less than 2 patients.On the day of surgery, the patient was draped and sterilized innormal fashion and bilateral marginal and transcolumellar incisionswere created. Raising the skin-soft tissue envelope revealed under-developed lower lateral cartilages and complete absence of upper lat-eral cartilages. The nasal bones also appeared underdeveloped. Theanterior septal angle could not be appreciated upon midline dissection.Bilateral mucosal ﬂaps were raised and dissected posteriorly to thebony septum, which was present. There was complete absence of car-tilaginous septum.We then proceeded with the nasal reconstruction portion of thecase. Two separate costochondral cadaveric cartilage grafts were se-lected and soaked in gentamicin solution. These were then carved usinga dermatome blade and allowed to set in order to assess for warping.Two solid struts were selected to be fashioned into an L-strut. Thecaudal strut was sutured into position with 3-0 PDS suture after placinga drill hole in the anterior nasal spine of the maxilla. The dorsal strutwas carved so that it accepted the nasal bones and stayed in position.Caudal and dorsal struts were then carved to accept one another andapproximated using 5-0 PDS suture. Soft tissue from the region wherehttps://doi.org/10.1016/j.xocr.2019.01.006Received 22 May 2018; Received in revised form 9 January 2019; Accepted 23 January 2019∗ Corresponding author.E-mail address: Dominick.gadaleta@jeﬀerson.edu (D. Gadaleta).Otolaryngology Case Reports 10 (2019) 25–26Available online 24 January 20192468-5488/ © 2019 Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/BY-NC-ND/4.0/).Tupper lateral cartilages would normally be was resuspended to thedorsal strut in an attempt to widen the internal nasal valve. After se-curing the L-strut, we turned to the Tasman technique to fashion ourdorsal onlay graft from diced cartilage and Tisseel. A 5 cc syringe wascarefully cut diagonally along its long axis with a #15 blade scalpel.Cadaveric cartilage was diced into pieces of 0.5 mm or less. They wereplaced in the modiﬁed syringe along with Tisseel ﬁbrin sealant (BaxterHealthcare Corp., Deerﬁeld, IL) and left to formulate. It was then usedas an onlay graft along the dorsum from the radix to the nasal tip. Anyremaining cadaveric cartilage was crushed and used to reconstructcartilaginous septum. A medial crura ﬁxation stitch was incorporatedinto the caudal strut in order to resupport the lower lateral cartilagesand provide adequate tip support. Mucosal ﬂaps were reapproximatedand the nasal skin was redrapped without diﬃculty. All incisions wereclosed in normal fashion without need for local tissue rearrangement orﬂaps.DiscussionCongenital absence of nasal cartilage is a rare entity, but one thathas a profound impact on both function and cosmesis of the nose. Thegoal of this case report is to outline the novel use of the previouslydescribed Tasman technique for nasal reconstruction in a patient withcongenital absence of nasal cartilages.The Tasman technique was developed out of need for a stable, ro-bust dorsal onlay graft that would avoid migration and warping as seenwith costal cartilage, as well as resorption. The current literatureavailable on this technique describe its successful application for largedorsal defects. There are no reports in the literature that describe ap-plying this technique to patients with congenital absence of nasalcartilages. Our patient was followed for two months postoperatively,and in that time reported improvement to her nasal breathing anddisplayed no evidence of graft resorption or migration (Fig. 2). Addi-tional follow ups will be necessary to determine the graft's long-termintegrity.ConclusionCongenital absence of nasal cartilage is a rare phenomenon, pre-senting challenges for both the patient and the reconstructive surgeon.In this article, we describe the challenges associated with undertakingsuch a reconstruction. Speciﬁcally, we describe successful im-plementation of fragmented cadaveric rib graft and Tissel to create acustom dorsal onlay graft.FundingThis research did not receive any speciﬁc grant from fundingagencies in the public, commercial, or not-for-proﬁt sectors.Appendix A. Supplementary dataSupplementary data to this article can be found online at https://doi.org/10.1016/j.xocr.2019.01.006.References[1] Baker S. Diced cartilage augmentation. Arch Facial Plast Surg 2012;14(6):451.[2] Tasman A, Diener P, Litschel R. The diced cartilage glue graft for nasal augmentation.JAMA Facial Plast Surg 2013;15(2):86.Fig. 1. Preoperative photographs.Fig. 2. Postoperative photographs, two months.D. Gadaleta, R. Heﬀelﬁnger Otolaryngology Case Reports 10 (2019) 25–2626

Application of Tasman technique for congenital absence of nasal cartilage: A case report

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Application of Tasman technique for congenital absence of nasal cartilage: A case report

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