Dorsal Augmentation with Autogenous Rib Cartilage

Abstract

Reconstruction of the nasal osseocartilaginous framework is the foundation of successful primary and secondary rhinoplasty. When adequate septal cartilage is unavailable, the rib provides the most abundant source of cartilage for graft fabrication and is the most reliable when structural support is needed. We present the senior author's (J.P.G.) experience and evolution of techniques of dorsal augmentation with autogenous rib cartilage grafts with internal K-wire stabilization in rhinoplasty.

Dorsal Nasal Augmentation: Is the Composite Graft Consisting of Conchal Cartilage and Retroauricular Fascia an Effective Option?

“…In more severe deficiencies, the cartilage and fascia pieces were superimposed, and a multilayer conchal and fascia graft was used. [12][13][14][15][16][17][18][19] Septal cartilage is one of the most common donor sites for dorsal augmentation. It has a flat contour and can be harvested easily through the rhinoplasty incisions, and there is no need to involve other sites of the patient's body for graft harvesting.…”

“…In addition, it tends to fragment when crushed and must be splinted to prevent warping. 6,7,[13][14][15] Conchal cartilage is widely used for primary and secondary rhinoplasty. Different methods have been applied for harvesting, preparing, and applying this graft.…”

“…If the dorsal deficiency was moderate, then 1 layer of the conchal cartilage was used. In more severe deficiencies, the cartilage and fascia pieces were superimposed, and a multilayer conchal and fascia graft was used (Figs 13,14). The graft was fixed at VAREDI AND BOHLULI the level of the radix with 2 pull-out 4-0 nylon sutures.…”

“…Various donor sites (including the nasal septum, conchal cartilage, and rib) are available for cartilage harvesting in rhinoplasty. [8][9][10][11][12][13][14][15] For most surgeons, the septal cartilage is the donor site of choice; however, if the septal cartilage is inadequate (eg, in patients with septal perforation) or in revision cases (in which the septal cartilage has been used in previous surgery), then the surgeon must choose other options. In these conditions, the conchal cartilage is a favorable choice.…”

Injerto costal para reconstrucción nasal: Experiencia de 6 años en el Hospital San Juan de Dios

“…Como se mencionó anteriormente, el mejor uso del cartílago costal es para el aumento del dorso nasal, sobre todo en casos de nariz en silla de montar, no así para el manejo de la punta nasal 13,14 . También se ha planteado el uso de cartílago costal a la hora de realizar cirugías estéticas nasales en pacientes con fisuras labiopalatinas 15 .…”