Onlay Rib Bone Graft in Elevation of Reconstructed Auricle: 17 Years of Experience

Abstract

BackgroundA cartilage wedge block and covering flap are standard procedures for firm elevation of the ear in microtia correction. However, using costal cartilage for elevation of the reconstructed auricle can be insufficient, and the fixed cartilage wedge block may be absorbed or may slip out. Furthermore, elevating covering flaps is time-consuming and uses up fascia, a potential source of reconstruction material. Therefore, we propose an innovative method using autologous onlay rib bone graft for auricular elevation of microtia.MethodsFrom February 1995 to August 2012, 77 patients received a first stage operation with a rib cartilage framework graft. In the second stage operation, a small full thickness of rib bone was harvested through the previous donor scar. The bihalved rib bone was inserted into the subperiosteal pocket beneath the cartilage framework.ResultsThe follow-up time ranged from 1 month to 17 years, with a mean of 3 years. All of the patients sustained the elevation of their ears very well during the follow-up period. Donor site problems, except for hypertrophic scars, were not observed. Surgery-related complications, specifically skin necrosis, infection, or hematoma, occurred in 4 cases.ConclusionsOnlay rib bone graft used to elevate the reconstructed auricle is a more anatomically appropriate material than cartilage, due to the bone-to-bone contact between the bone graft and the temporal bone. Postoperative minor correction of the elevation degree is straightforward and the skin graft survives better. Therefore, reconstructed auricle elevation using onlay rib bone graft is a useful and valuable method.

Hybrid columellar strut using nasal crest bone of the maxilla and conchal cartilage for nasal tip stability in rhinoplasty for East Asian patients

“…Many studies have reported a positive correlation between the surgical time and complication rate [18]. Costal cartilage harvesting is also accompanied by donor-site morbidities such as pneumothorax, hemothorax, atelectasis, infection, seroma, visible chest scars, and chronic postoperative pain [19]. Despite their low incidence, acute morbidities (e.g., pneumothorax, hemothorax, and atelectasis) can be life-threatening when appropriate care fails [20].…”

Zygomaticomaxillary “lateral swing” osteotomy for augmentation of midface deficiency

“…[12] Some authors consider cartilage as the graft of choice for orbitozygomatic reconstruction owing to its ease of carving a complex graft shape. [9] There is always a concern of bone resorption; however, Kim et al [13] and others reported that costal bone grafted on the facial area maintained its volume even after a 17-year follow-up of their case.…”