Osseocartilaginous rib graft rhinoplasty: a stable, predictable technique for major dorsal reconstruction

Christophel JJ, Hilger PA.

What this paper says

In 39 patients who had a rib graft laid on the bridge of the nose, all 33 grafts containing both bone and cartilage stayed solid and held their height, none warped, and 30% had a revision, mostly minor cosmetic.

Overview

Rebuilding a collapsed nasal bridge needs a large, strong graft. Rib cartilage is the usual source but can bend over time. The authors reviewed ten years of rib graft rhinoplasties from one practice to see whether grafts that keep a segment of rib bone attached to the cartilage stay straight and in place.

Sections of note

Retrospective cohort, 2000 to 2009, with telephone follow-up; 58 rib graft rhinoplasties, 39 with dorsal onlay grafts.
Mean clinical follow-up 24 months, median 16 months.
33 of 33 bone-plus-cartilage onlay grafts (100%) and 5 of 6 cartilage-only grafts (83%) were viable, rigid and held dorsal projection at last visit.
No graft warped.
Nasal obstruction relief persisted in 29 of 33 (88%) with bone-plus-cartilage grafts and 5 of 6 (83%) with cartilage-only grafts.
12 of 39 patients (30%) had revision surgery, mostly minor cosmetic revision.
Indications included saddle deformity, trauma and multiple prior septorhinoplasties.

What it means for a patient

For a badly collapsed bridge, a rib graft that keeps some bone attached held its shape in every case in this series and fused to the nasal bones.
Breathing improved and stayed improved in most patients.
Nearly one in three had a further operation, so a touch-up is common after major reconstruction.
Single practice, no comparison group, and follow-up was partly by telephone rather than examination.

Why this paper matters

Warping is the main long-term worry with rib cartilage on the dorsum. This series supports the osseocartilaginous graft as a stable option for major reconstruction. The abstract does not report donor site problems in numbers, and the cartilage-only group was too small to compare.

Terms

Dorsal onlay graft: a graft laid along the top of the bridge to raise or straighten it.
Osseocartilaginous: containing both bone and cartilage, here a rib segment with its cartilage attached.
Saddle deformity: a sunken bridge caused by loss of septal support.
Warping: a cartilage graft bending after it is placed.
Dorsal projection: how far the bridge stands out from the face in profile.
Retrospective cohort: a study that looks back at records of patients already treated.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

From the abstract

“To assess the long-term stability of osseocartilaginous dorsal onlay rib grafts used for augmentation rhinoplasty. Methods: Patients who had rib grafts used for augmentation rhinoplasty from 2000 through 2009 were assessed for graft viability, graft mobility, graft warping, maintenance of dorsal projection, functional…”

Excerpt; the full abstract is on PubMed.