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Editor's Correspondence |

The “Inverted V” Technique for Rib Cartilage L-Shaped Struts in Rhinoplasty

Paolo Persichetti, MD, PhD; Vito Toto, MD; Francesco Segreto, MD; Daniele Tosi, MD; Stefano Campa, MD; Giovanni Francesco Marangi, MD
Arch Facial Plast Surg. 2012;14(6):466-467. doi:10.1001/jamafacial.2013.301.
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We read with great interest the article by Moon et al1 titled “Outcomes Following Rhinoplasty Using Autologous Costal Cartilage.” In their study, the authors describe the use of autologous costal cartilage in primary and revision rhinoplasty patients affected by a flat nose and poor nasal tip definition. As pointed out by the authors, the main problem in these cases is the fragility and the insufficient bearing capacity of the costal cartilage graft. We congratulate the authors for their work, and we would like to share our experience in this field by describing a simple technique to improve shape correction and costal cartilage graft stability. Our technique can be used both in open and closed rhinoplasties. Costal cartilage is harvested as described by Marin et al2 and partially carved to obtain a dorsal onlay graft. Inferiorly, in the downward face of the graft, the cartilage is carved to shape an inverted V; the cut does not extend beyond the half of graft thickness. A bony fixation platform is prepared by disarticulating the bony triangle of the radix. The dorsal onlay graft is then fixed to the frontal bone by mean of a 0.0035-in Kirshner wire longitudinally penetrating the cartilage. Subsequently, we carve 1 extremity of the inferior element of the L-strut to fit the inverted V of the dorsal onlay graft. This graft is placed between the middle or medial crura down to the nasal spine and then fixed to the dorsal graft with a 3-0 PDS suture (Figure 1).

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Figure 1. Surgical technique. A, Inferior view of the L-shaped strut. The inverted V fits with the narrowed extremity of the columellar strut; the suture goes through the dorsal onlay graft below the Kirschner wire. B, The 2 grafts placed in position.

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Figure 2. A 59-year-old former boxer referred to our department for severe posttraumatic nasal deformity with crooked nose and boxy nasal tip. Costal cartilage was harvested from the seventh rib. Preoperative and postoperative basal (A and B) and lateral (C and D) views.

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