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Biomechanical Testing of the Tripod Theory Based on a Cantilevered Model

Richard W. Westreich, MD; Hayden-William Courtland, MS; Philip Nasser, MSME, MSEE; Karl Jepsen, PhD; William Lawson, MD, DDS

Arch Facial Plast Surg. 2007;9(4):264-270.

Objective  To define the modulus of elasticity for nasal septum, auricular, upper lateral, and lower lateral cartilages.

Methods  Prospective enrollment of sequential patients undergoing septorhinoplasty. Test samples were obtained through routine surgical interventions using atraumatic harvesting techniques. The modulus of elasticity was determined using a customized biomechanical testing device. A clinical analysis of nasal tip strength and "ethnic" nasal categorization was performed.

Results  Five sequential patients were enrolled; 4 underwent biomechanical testing of harvested cartilage. All 4 patients were classified as having a leptorrhine nasal architecture. The modulus of elasticity for the lower lateral cartilages was 1.82 to 15.28 MPa. Values for auricular, nasal septum, and upper lateral cartilages (medial and caudal) were also determined.

Conclusions  This is the first biomechanical study performed on human auricular, lower lateral, and upper lateral cartilages. The elastic modulus can be determined from samples obtained during routine septorhinoplasty. The modulus of elasticity for all areas was significantly higher than values previously demonstrated for bioengineered elastic cartilage and carved human nasal septal specimens. Shaving the lateral portions of the nasal septum may significantly reduce tensile strength, which may affect graft performance in vivo. Further refinement of testing methods and an increase in the number of analyzed samples are required for formal statistical analysis and further determination of clinical relevance in different nasal subtypes.

Author Affiliations: Departments of Otolaryngology, State University of New York Downstate Medical Center, Brooklyn, and Long Island College Hospital, Brooklyn (Dr Westreich); and Leni and Peter W. May Department of Orthopaedics (Messrs Courtland and Nasser and Dr Jepsen) and Department of Otolaryngology (Dr Lawson), Mount Sinai Hospital, New York, New York.