Introduction: Complex reconstructive septorhinoplasty requires harvesting a large amount of tissue for grafting. Autogenous costochondral and auricular cartilage has generally considered the gold standard grafting material, if insufficient septal cartilage remains. The aim of this paper was to describe our technique and report our experience with the use of costal cartilage grafts in cases with significant nasal deformities with insufficient septal cartilage.
Design: Retrospective review of patients who underwent septorhinoplasty with costochondral grafts between 1995 and 2015.
Results: Over a 20-year period from 1995 to 2015, a total of 711 rhinoplasties were carried out at Aintree University Hospital, Liverpool. Of these, 46 (5.7%) utilized costal cartilage as the material to provide skeletal support. Male to female ratio was 2:1, and mean age was 34 years (15–56); 22 presented with congenital deformity and 24 with acquired deformity. All had severe nasal collapse (grades III and IV).
Conclusion: Costal cartilage is the ideal material for reconstruction of severe saddle noses. There are no crossinfection risks, the donor site is low morbidity, it is easy to harvest, has a plentiful supply, and is easy to carve and sculpt. The tendency to warping is a disadvantage, but this can be prevented in most cases by careful attention to technique, and is usually easy to correct by minor revision where necessary. It is usually dimensionally stable and is able to resist infection, and where exposure occurs due to wound breakdown, it will heal without total graft loss.
Dresner HS1, Hilger PA. An overview of nasal dorsal augmentation. Semin Plast Surg. 2008 May;22(2):65-73.
Kawanabe Y, Nagata S. A new method of costal cartilage harvest for total auricular reconstruction: part I. Avoidance and prevention of intraoperative and postoperative complications and problems. Plast Reconstr Surg. 2006 May;117(6): 2011-2018.
Varadharajan K1, Sethukumar P1, Anwar M1, Patel K1. Complications Associated With the Use of Autologous Costal Cartilage in Rhinoplasty: A Systematic Review. Aesthet Surg J. 2015 Aug;35(6):644-652.
Chummun S, McLean NR, Anderson PJ, David DJ. A long-term evaluation of 150 costochondral nasal grafts. J Plast Reconstr Aesthetic Surg. 2013;66:1477-1481
Wee JH, Park M-H, Oh S, Jin H-R. Complications Associated With Autologous Rib Cartilage Use in Rhinoplasty A Metaanalysis. JAMA Facial Plast Surg. 2015;17(1):49-55.
Holmes AD, Lee SJ, Greensmith A, Heggie A, Meara JG. Nasal Reconstruction for Maxillonasal Dysplasia. J Craniofac Surg 2010 Mar; 21(2): 543-551.
Li D, Mao H, Yu Z, Xu L, Yuan J, Wei M. Primary aesthetic correction of nasal anomaly with costal graft in treating orbital hypertelorism. J Cranio Max Fac Surg. 2018;46::6-10
Baek RM, Lee Y, Song YT. Overgrowth of a costochondral graft in nasal reconstruction. J Craniofac Surg. 2005 Jul;16(4):736-740.
Gibson T, Davies WB. The distortion of autogenous cartilage grafts: its causes and prevention. Br J Plast Surg. 1958;010:257-274.
Kim DW, Shah AR, Toriumi DM. Concentric and eccentric carved costal cartilage: a comparison of warping. Arch Facial Plast Surg. 2006;8:42-46
Balaji SM. Costal cartilage nasal augmentation rhinoplasty: Study on warping. Ann Maxillofac Surg. 2013 Jan-June;3(1): 20-24.
Kapil S. Agrawal, Manoj Bachhav, and Raghav Shrotriya. Namaste (counterbalancing) technique: Overcoming warping in costal cartilage. Indian J Plast Surg. 2015 May-Aug;48(2):123-128.
Ozturano, Aksoy F, Veyseller B, Apuhan T, Yildirim YS. Severe saddle nose: choices for augmentation and application of accordion technique against warping. Aesthetic Plast Surg. 2013 Feb;37(1):106-116.
Gunter JP, Clark CP, Friedman RM. Internal stabilization of autogenous rib cartilage grafts in rhinoplasty: a barrier to cartilage warping. Plast Reconstr Surg. 1997;100: 161-169.
Al-Qattan MM. Augmentation of the nasal dorsum with autogenous costal cartilage using the “edge-on” technique. Ann Plast Surg. 2007 Dec;59(6):642-644.
Yeon Hee Joo, Yong Ju Jang. Comparison of the Surgical outcomes of Dorsal Augmentation using Expanded Polytetrafluoroethylene or Autologous Costal Cartilage. JAMA Facial Plast Surg. 2016;18(5);327-332.
Wee JH, Mun SJ, Na WS, Kim H, Park JH, Kim DK, Jin HR. Autologous vs Irradiated Homologous Costal Cartilage as Graft Material in Rhinoplasty 183-188. JAMA Facial Plast Surg 2017 May 1;19(3):183-186.
Moon BJ, Lee HJ, Jang YJ. Outcomes Following Rhinplasty using Autologous Costal Cartilage. Arch facial Plast Surg. 2012;14(3):175-180.