Reconstructive Rhinoplasty Using Multiplanar Carved Costal Cartilage

Overview

Major nasal reconstruction usually needs cartilage, and a full-thickness rib graft supplies a large uncarved block. Warping is the recognised drawback. The authors describe carving that block across multiple planes so its shape mimics normal nasal anatomy and its internal structure resists bending, then reviewed their consecutive cases.

Sections of note

• Retrospective review of 11 consecutive patients with complex nasal deformity, treated at the University of New Mexico Hospital between January 2010 and December 2014.
• Follow-up ranged from 3 to 36 months.
• A full-thickness rib segment was harvested, its natural curvature removed to leave a uniform symmetric block, then carved in three dimensions through an open rhinoplasty approach.
• The most common application was reconstructing the septum together with the upper lateral cartilage.
• There were no major complications and no patient experienced graft warping during follow-up.
• Several patients required minor revision procedures. All patients reported improved airway and improved appearance. NOSE scores were documented in most cases, obtained at least three months after surgery. Level of evidence 4.

What it means for a patient

• This applies to major reconstruction, where the nose has lost substantial structure, not to routine cosmetic rhinoplasty.
• Warping of rib cartilage is the usual concern with this graft, and no patient in this small series had it.
• Several patients still needed a minor further procedure, so the technique did not remove the need for touch-ups.
• Eleven patients, single centre, retrospective, no comparison technique, and NOSE scores are mentioned without reported values.

Why this paper matters

Warping limits confidence in rib grafts for large reconstructions, and most solutions involve dicing the cartilage or balancing the carve. Carving across multiple planes to mimic the anatomy is a different approach. With 11 patients and follow-up as short as three months in some cases, the absence of warping is encouraging rather than established.

Terms

• Reconstructive rhinoplasty: surgery to rebuild a nose damaged by injury, disease or previous operations.
• Costal cartilage: cartilage from the ribs.
• Multiplanar carving: shaping a graft across several planes rather than as a flat piece.
• Warping: gradual bending of a cartilage graft after it is placed.
• Upper lateral cartilage: the paired cartilages forming the middle third of the nose.
• NOSE score: a validated questionnaire scoring nasal obstruction.