**6. Temporalis fascia**

Temporalis fascia is a well-established augmentation material in rhinoplasty. To harvest temporalis fascia, after proper application of local anesthesia, a 5 cm incision is done in posterior neck hair line with anterior and upward dissections adequate access is gained to the superficial layer of the deep temporalis fascia. Adequate amount of fascial tissue is harvested and the donor site is precisely sutured after complete control of bleeding. Temporalis fascia provides a soft and smooth layer that may cover dorsal irregularities. It may be used for minimal dorsal augmentations and for greater amounts of augmentation it should be com‐ bined with other grafting techniques otherwise alternatives may be selected. [32,33]

#### **6.1. Postauricular fascia**

Postauricular and mastoid fascia provide a thick fascial tissue that is easily harvested with a 4cm curvilinear incision exactly behind the ears; incision lines are completely concealed behind the ears in normal skin creases and the risk of complications comparing to donor sites in the temporalis fascia is quiet low. This fascial tissue may be used in moderate dorsal augmenta‐ tions (Figure 6). [34]

acceptable results (**Figure 7**). ( (35, <sup>36</sup>

**Figure 6.** Post-auricular fascia harvesting

#### **6.2. Turkish delight**

**Figure 6: Post‐auricular fascia harvesting Turkish delight‐4** Turkish delight is an efficient technique that was originally designed by Erol in 2000. This technique was aimed to solve essential problems that were frequently encountered in the use of cartilage blocks from the nasal septum or Turkish delight is an efficient technique that was originally designed by Erol in 2000. This technique was aimed to solve essential problems that were frequently encountered in the use of cartilage blocks from the nasal septum or ribs. In Erol's original report rib cartilage was delicately diced into small particles, then soaked in blood and wrapped in Surgicel. Daniel wrapped the diced cartilages in temporalis fascia to omit the unpredictable behavior of Surgicel (oxidized cellulose) coverage. Diced cartilage wrapped in fascia is now commonly utilized in augmentation rhinoplasty and is reported to have acceptable results (Figure 7). [35,36]

ribs. In Erol's original report rib cartilage was delicately diced into small particles, then soaked in blood and wrapped in Surgicel. Daniel wrapped the diced cartilages in temporalis fascia to omit the unpredictable behavior of Surgicel (oxidized cellulose) coverage. Diced cartilage wrapped in fascia is now commonly utilized in augmentation rhinoplasty and is reported to have

**Figure 7: Turkish delight**

block graft ( (37 .

**Fascia‐cartilage sandwich technique‐5**

**Internal nasal valve incompetency**

**Figure 7.** Turkish delight

minimal dorsal augmentations and for greater amounts of augmentation it should be com‐

Postauricular and mastoid fascia provide a thick fascial tissue that is easily harvested with a 4cm curvilinear incision exactly behind the ears; incision lines are completely concealed behind the ears in normal skin creases and the risk of complications comparing to donor sites in the temporalis fascia is quiet low. This fascial tissue may be used in moderate dorsal augmenta‐

**Figure 6: Post‐auricular fascia harvesting**

Turkish delight is an efficient technique that was originally designed by Erol in 2000. This technique was aimed to solve essential problems that were frequently encountered in the use of cartilage blocks from the nasal septum or ribs. In Erol's original report rib cartilage was delicately diced into small particles, then soaked in blood and wrapped in Surgicel. Daniel wrapped the diced cartilages in temporalis fascia to omit the unpredictable behavior of Surgicel (oxidized cellulose) coverage. Diced cartilage wrapped in fascia is now commonly utilized in augmentation rhinoplasty and is reported to have

Turkish delight is an efficient technique that was originally designed by Erol in 2000. This technique was aimed to solve essential problems that were frequently encountered in the use of cartilage blocks from the nasal septum or ribs. In Erol's original report rib cartilage was delicately diced into small particles, then soaked in blood and wrapped in Surgicel. Daniel wrapped the diced cartilages in temporalis fascia to omit the unpredictable behavior of Surgicel (oxidized cellulose) coverage. Diced cartilage wrapped in fascia is now commonly utilized in augmentation rhinoplasty and is reported to have acceptable results (Figure 7). [35,36]

**Turkish delight‐4**

acceptable results (**Figure 7**). ( (35, <sup>36</sup>

bined with other grafting techniques otherwise alternatives may be selected. [32,33]

**6.1. Postauricular fascia**

776 A Textbook of Advanced Oral and Maxillofacial Surgery Volume 2

tions (Figure 6). [34]

**6.2. Turkish delight**

**Figure 6.** Post-auricular fascia harvesting

#### **6.3. Fascia-cartilage sandwich technique**

Fascia‐cartilage sandwich is reasonable alternative to rib grafts. In this technique temporalis or mastoid tissue is harvested, cartilage block from nasal septum or chonchal tissue is trimmed and formed in its ideal contour, and then it is covered with fascia. In fact cartilage provides the bulk of augmentation material and fascia covers the possible irregularities and shadows of a cartilage Fascia-cartilage sandwich is reasonable alternative to rib grafts. In this technique temporalis or mastoid tissue is harvested, cartilage block from nasal septum or chonchal tissue is trimmed and formed in its ideal contour, and then it is covered with fascia. In fact cartilage provides the bulk of augmentation material and fascia covers the possible irregularities and shadows of a cartilage block graft [37]

#### **6.4. Internal nasal valve incompetency**

Sometimes pre‐operative evaluations show that one or both internal nasal valves are incompetent and do not work well. On the other hand in major hump resections (more than 3mm); nasal valve reconstruction will be necessary. For this reason, internal nasal valve reinforcement is commonly Sometimes pre-operative evaluations show that one or both internal nasal valves are incom‐ petent and do not work well. On the other hand in major hump resections (more than 3mm); nasal valve reconstruction will be necessary. For this reason, internal nasal valve reinforcement is commonly indicated and may be indicated in most cases. The followings are some of effective valve reinforcement techniques:


the main advantage of this technique is its reversibility and when an ideal result is not obtained intra-operatively, the sutures can be removed. Upper lateral cartilages are conservatively trimmed and other standard valve reconstruction techniques such as spreader grafts may be applied (Figure 8).[40-42]

**Figure 8.** Autospreader

**3. Docile splay graft**: The docile splay graft is a piece of septal cartilage that is gently crushed and is placed over the nasal septum in a way that it covers the nasal septum and the two upper lateral cartilages are located laterally to the graft. It is believed that this simple graft will prevent upper lateral cartilages from functional movements and collapse [43]

#### **6.5. Important points**

