Specially processed heterogenous bone and cartilage transplants in nasal surgery.

IN nasal surgery, cartilage or bone transplants are required for support or correction of cosmetic deformities. When autogenous material is readily available, it should be used in preference to homogenous or heterogenous material. Sometimes this means, however, an iliac bone or rib cartilage graft. These procedures have a certain morbidity and the grafts are not always readily accepted by the patient. For this reason, there is a place for heterografts, especially when their antigenicity is reduced. Embryo calf bone and cartilage can be specially treated by lyophilization and surface active agents to reduce its antigenicity (Dingwall and Millonig, 1964) and this material has been used in the present clinical study. Cartilage and bone transplants are often required to maintain support and resist deforming forces. It has been shown (Clark, 1968) that a septal strut of heterogenous bone can be effective in supporting the nasal dorsum in a patient with a saddle nose due to injury. Consequently, this study has been undertaken to see how well the specially-processed heterogenous bone and cartilage would resist deforming forces and become incorporated into the host tissues. It was considered necessary to use the material in a number of different sites as this would enable one to assess better the effects of different degrees of muscle pull and tissue tension on the rate of its absorption. Assessment of absorption and rejection in the septum can be made difficult by limited access. This was another reason why subcutaneous and other sites were selected, so that absorption could be better assessed by inspection and palpation. This clinical study has been undertaken in seven patients with a variety of problems due to loss of support of one or more nasal structures. As there had been no previous evidence that the material was superior to autogenous transplants, the specially-processed bone and cartilage were only used in patients where sufficient autogenous material could not be obtained, and after discussion with the patient.