The Role of Apoptosis in Traumatic versus Nontraumatic Nasal Septal Cartilage

Nasal surgery is occasionally performed to correct traumatic nasal deformity. Septal cartilage is the main tissue to be corrected and is a graft source when needed. A risk in engrafting with cartilage is the possibility of resorption as a result of either necrosis or apoptosis. The authors evaluated the rate of apoptosis in deviated and straight cartilage to investigate the cause of resorption of cartilage tissue. Twenty-five patients with traumatic nasal septum deviation (group I) and 13 patients with nontraumatic nasal septum deviation (group II) were prospectively enrolled. After correction of the deviation, two small samples of cartilage were harvested, one from the deviated site (group Ia or IIa) and the other from the straight site (group Ib or IIb), immediately frozen at -70 masculineC, and evaluated for apoptosis using DNA agarose gel electrophoresis. Apoptosis was detected in 14 (56 percent) of the deviated and two (8 percent) of the straight cartilage samples in traumatic patients, whereas it was detected in only one deviated sample (7.7 percent) and none of the straight samples in nontraumatic patients. The apoptosis rates in group Ia were statistically significant when compared with groups Ib (p = 0.0007) and IIa (p = 0.0007). The present study demonstrates that apoptosis occurs in traumatized nasal septal cartilage. Apoptosis might be the factor leading to cartilage resorption, weakness, and warping when used as a graft. Thus, cartilage grafting materials should be taken from the nontraumatized portion of the septum and should not be traumatized either during harvesting or before placement.