The authors discuss a common problem involving the loss or damage to the  nasal septum. The most common causes are iatrogenic and previous surgery. The loss of the nasal septum is frequently also seen in repeated trauma and reconstruction using auricular cartilage is effective. However, the use of this cartilage involves making the ‘bowl’ cartilage straight and imparting it with strength to support the nose to allow for adequate nasal functioning. This paper from authors in Italy discusses the aetiology and pathogenesis of the loss of nasal cartilage and then progresses to patient analysis. Both these sections are well covered and the use of excellent colour photographs enhances the educational value. They describe their technique of converting a curved flexible cartilage to a straight one, and increasing the structural strength using partial thickness incisions and figure of eight sutures. There is an extensive review and discussion with good clinical photographs. Various donor sites are discussed as are the pros and cons. The importance of the effective support, in the form of the cartilaginous septum, as a prerequisite is again discussed. The paper is well written and discusses the use of auricular cartilage to reconstruct the deficient nasal septum, and techniques to improve the stability and function of the graft. 

Subtotal septal reconstruction by using conchal graft.
Boccieri A, Marianetti T.
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Sunil K Bhatia

Royal Shrewsbury Hospital, Shrewsbury, UK.

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