Costal Cartilage Calcification in a Caucasian Population: Machine Learning Recommendations for Chest CT-guided Rhinoplasty Planning

van Dam VS, Berzenji D, van den Berg AS, van Zijl FVWJ, Nagtegaal AP, Kremer B, Datema FR.

PubMed 41145129 Publisher (DOI)Free full text (PMC)

What this paper says

In 662 Caucasian adults, 89.6% had some rib cartilage calcification, and a machine-learning model recommended a preoperative chest CT for women over 23 and men over 40 before rib-cartilage rhinoplasty.

Overview

Calcified rib cartilage is hard to carve and can compromise a graft. The authors, from a Dutch academic centre, retrospectively reviewed chest CT scans of 662 Caucasian adults. Three independent reviewers graded the presence, severity and pattern of calcification in ribs five to eight, and a machine-learning algorithm identified sex-specific age thresholds beyond which a CT would likely show calcification relevant to surgical planning.

Sections of note

Overall prevalence of costal cartilage calcification: 89.6%.
Nearly everyone over 50 had some calcification.
Young women had more severe and more prevalent calcification in the central core of ribs five to eight than age-matched men.
Recommended CT threshold: women over 23 years, men over 40 years.
No upper age limit for rib use could be derived from the data.

What it means for a patient

Rib cartilage is not uniformly usable; calcification is common and starts earlier in women.
A chest CT before surgery can tell the surgeon which rib to use or whether to choose another graft source.
The findings apply to a Caucasian population and may differ elsewhere.

Why this paper matters

It gives an evidence-based, sex-specific rule for when to image the ribs before rhinoplasty, replacing surgeon guesswork. Limits: cross-sectional, one ethnic group, CT findings not linked to actual surgical outcomes.

Terms

Costal cartilage: rib cartilage, the largest source of graft material for the nose.
Calcification: deposition of calcium that turns flexible cartilage hard and brittle.
Chest CT: a computed tomography scan of the thorax.
Machine learning: statistical software that finds patterns in data to make predictions.
Donor site: the part of the body from which a graft is taken.

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

Abstract

Introduction: Autologous costal cartilage calcification (CCC) can impact the course and long-term results of rhinoplasty. Preoperative information about the presence, severity, and pattern of CCC helps to assess donor site suitability and rhinoplasty planning.

Objective: To use machine learning to identify a sex-specific age threshold beyond which a preoperative chest CT is likely to reveal CCC relevant for rhinoplasty planning.

Study Design: Cross-sectional retrospective study of 662 Caucasian adults.

Methods: Prevalence, severity, and patterns of CCC in ribs five to eight were assessed by three independent reviewers. A machine learning algorithm was used to predict the age threshold beyond which a chest CT scan is beneficial to rhinoplasty planning.

Results: The prevalence of CCC in Caucasian adults was 89.6%. Nearly all individuals over the age of 50 exhibited some form of CCC. In young females CCC was more severe and prevalent in the central core of ribs five to eight compared with age-matched males.

Conclusion: A chest CT is recommended in females over 23 years and males over 40 years. No data-driven recommendations regarding an upper age limit for costal cartilage use could be determined from the data.

Abstract as indexed by PubMed; the article is open access (PubMed Central).