Clinical Results of Using Autologous Bone Plates to Correct Quadrangular Cartilage Deformitiesin Rhinoplasty

Purpose of the Study. To evaluate the clinical outcomes of using autologous bone tissue from the perpendicular plate of the ethmoid bone to correct deformities of the quadrangular cartilage of the nasal septum during rhinoseptoplasty in patients with severe nasal septum deviation and concomitant deformity of the external nose.
Material and methods. A retrospective study was conducted from January 2022 to October 2025 at St. Petersburg State Pediatric Medical University. It was approved by the local ethics committee (protocol No.32/06 dated August 11, 2023) and performed in accordance with the principles of the Declaration of Helsinki. The study included 30 patients who underwent rhinoseptoplasty using the perpendicular plate of the ethmoid bone. Demographic data, surgical technique, and duration were recorded, and photographic documentation was performed. Follow-up examinations were performed at 1, 3, 6 months after the intervention. Subjective results after 6 months were assessed using the validated SCHNOS scale, objective functional indicators were determined using the anterior active rhinomanometry method. The surgical technique included a transcollumelar approach with subperichondrium and subperiosteum detachment of the mucosa, complete mobilization of the cartilaginous portion of the septum, removal of deformed fragments, and subsequent placement of a perforated, diamond-thinned perpendicular plate of the ethmoid bone into the caudal portion of the septum with fixation to the quadrangular cartilage. When indicated, the intervention was supplemented with osteotomies and ostectomies. Statistical analysis was performed using SPSS Statistics v.27.0.1; the Kruskal-Wallis and Wilcoxon tests were used, the significance level was α=0.05. Results. In all three subgroups of patients (open, combined and closed approach), no statistically significant differences in gender and age were found, while the duration of the operation differed significantly between the groups (p=0.008). According to rhinomanometry data, the volumetric air flow significantly increased 6 months after the intervention – the median increased from 419.0 to 879.0 ml/s (p<0.001). The SCHNOS scale scores significantly improved 6 months after the operation in all subgroups compared to the baseline values (p<0.05). There were no infectious complications or cases of bone plate extrusion either in the early or late postoperative periods.
Conclusion. The use of autologous bone tissue from the perpendicular plate of the ethmoid bone is an effective and safe method for stabilizing and straightening the quadrangular cartilage of the nasal septum in severe deformities, providing significant improvement in both functional and aesthetic outcomes with minimal complications. This technique can, in some cases, avoid the need for rib grafts; however, it requires careful patient selection based on the nature of the deformity and surgical history. Limitations of the study include its retrospective design and relatively small sample size.
Key words: rhinoplasty, septoplasty, rhinoseptoplasty, nasal septum deformity, quadrangular cartilage, perpendicular plate of the ethmoid bone, autologous bone graft, preserving rhinoplasty, nasal breathing, rhinomanometry, SCHNOS scale, extracorporeal septoplasty, nasal septum deviance, osteochondral grafts, reconstructive nasal surgery
Conflict of interest. The authors declare no conflict of interest.
Financing. The work was completed without sponsorship.