Costal Cartilage Grafts in Rhinoplasty

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Key points

  • The use of costal cartilage in rhinoplasty carries with it a risk of both donor site and rhinoplasty complications. The decision to use costal cartilage should be made after considering the alternative sources of cartilage grafts.

  • After cartilage is harvested, the integrity of the chest wall and the absence of pneumothorax should be confirmed.

  • Costal cartilage has a significant risk of warping. Various technical considerations allow the surgeon to take advantage of or to minimize the warping of

Treatment goals and planned outcomes

Every rhinoplasty procedure has multiple goals. Foremost is the resolution of all the concerns of the patient. The procedure should be safe with a minimal risk of complications. Patient satisfaction with an achievement of the desired esthetic and functional goals is central to a good outcome. Technically, the procedure should be based on sound principles of surgery, healing, and esthetics.

In rhinoplasty, favorable outcomes are achieved as a result of careful analysis, diagnosis, communication,

Potential complications and management

Potential donor site complications include infection, pneumothorax, bleeding, hematoma, and pain. Recipient site complications include graft sizing issues, graft malposition, graft mobility, and warping. The donor site complications are relatively uncommon, but include persistent pain, seroma, and wound issues.16, 17

Among the most significant risk during the execution of costal cartilage harvesting is pneumothorax. Pneumothorax has been stated to occur in more than 20% of the time during costal

Summary

The limitations of available septal and auricular cartilage may compromise the results of a rhinoplasty procedure when restricted to the use of those 2 donor sites. The rib cage provides an enormous reserve of costal cartilage that can be carved into a variety of grafts necessary for the successful execution of several rhinoplasty techniques. In many circumstances, the available volume and characteristics of costal cartilage are optimal for a successful rhinoplasty operation. As with every

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References (19)

  • R.J. Rohrich et al.

    Ethnic rhinoplasty

    Clin Plast Surg

    (2010)
  • D.M. Toriumi et al.

    Asian rhinoplasty

    Clin Plast Surg

    (2010)
  • G.J. Nolst Trenite

    Considerations in ethnic rhinoplasty

    Facial Plast Surg

    (2003)
  • J.H. Park et al.

    Use of autologous costal cartilage in Asian rhinoplasty

    Plast Reconstr Surg

    (2012)
  • D.M. Toriumi

    Discussion: use of autologous costal cartilage in Asian rhinoplasty

    Plast Reconstr Surg

    (2012)
  • E.G. Whitaker et al.

    The evolution of open structure rhinoplasty

    Arch Facial Plast Surg

    (2003)
  • T.D. Zijlker et al.

    Open structure rhinoplasty

    Clin Otolaryngol Allied Sci

    (1993)
  • A.J. Burke et al.

    Irradiated homograft rib cartilage in facial reconstruction

    Arch Facial Plast Surg

    (2004)
  • G. Lefkovits

    Irradiated homologous costal cartilage for augmentation rhinoplasty

    Ann Plast Surg

    (1990)
There are more references available in the full text version of this article.

Cited by (30)

  • “An integrated clip-shaped costal cartilage carving approach for rhinoplasty”

    2022, Journal of Plastic, Reconstructive and Aesthetic Surgery
    Citation Excerpt :

    Additionally, warping is more obvious when costal cartilage is cut into several pieces for grafting.10 To overcome these drawbacks, it is best to carve from the central core of the rib into one en-bloc graft to minimize the effect of warping.11 Clip-shaped costal cartilage grafts provide an adequate framework that incorporates the properties of the septal extension graft and columellar struts to support the nasal tip.

  • Costal Cartilage Harvest

    2022, Rhinoplasty: A Case-Based Approach
  • Recent advances in bioprinting technologies for engineering different cartilage-based tissues

    2021, Materials Science and Engineering C
    Citation Excerpt :

    Moreover, CC represents an attractive and valuable source for grafting. As a matter of a fact, CC grafts are commonly used in craniofacial surgeries for mandibular reconstruction, in rhinoplasty, in tracheoplasty as a stent graft, and for auricular reconstruction [99–103]. However, to the best of our knowledge, no research study regarding CC tissue engineering or bioprinted CC scaffolds can be found in literature, thus highlighting the need to explore this CTE field of study.

  • Primary Rhinoplasty

    2016, Facial Plastic Surgery Clinics of North America
    Citation Excerpt :

    As with all aspects of surgery, the application of these principles should be individualized and applied with sound judgment. The rib is frequently used as a graft donor site for aesthetic and corrective rhinoplasty.31 Even in the situation of a primary rhinoplasty, there may be inadequate septal cartilage available to do the necessary grafting.

  • Experience harvesting costal cartilage under IV sedation

    2020, American Journal of Otolaryngology - Head and Neck Medicine and Surgery
    Citation Excerpt :

    Although a degree of debate exists on the ideal grafting material, autologous cartilage grafts are favored for their superior characteristics and their use seems to be increasing in frequency [1,2]. While numerous techniques for costal cartilage harvesting have been described, one consistency in the published literature is that the procedure is performed under general anesthesia [3,4]. In fact, it has generally been accepted dogma that costal cartilage harvest should always be done under general inhalational anesthesia [5].

View all citing articles on Scopus

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