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Original Investigation |

A Novel Technique for Sculpting Costal Cartilage in Microtia Repair and Rhinoplasty

Linda N. Lee, MD1; Kofi D. Boahene, MD1
[+] Author Affiliations
1Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
JAMA Facial Plast Surg. 2013;15(5):349-351. doi:10.1001/jamafacial.2013.1307.
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Importance  Transforming a block of costal cartilage into a complex 3-dimensional framework that reflects the contours of a normal ear or nasal bridge requires the creation of many subtle curves, concavities, and convexities. Thus, specialized instruments for microtia repair and rhinoplasty, with specifically curved sharp blades, are used for delicate carving without the need for excessive force, which can damage the framework. Several challenges are associated with these specialized instruments.

Objective  To describe a novel alternate technique using disposable skin punch biopsy instruments for sculpting cartilage, which have the potential to decrease cost, ensure consistently sharp blades, and provide a variety of sizes to allow precise, controlled contour changes.

Design  Surgical technique adapting a commercially available skin punch tool for costocondral sculpting.

Setting  Academic tertiary care medical center.

Participants  Patients undergoing microtia repair and rhinoplasty requiring sculpting of costocondral cartilage.

Main Outcomes and Measures  Feasibility and reliability of cartilage contouring.

Results  This novel technique has been used in microtia repair and rhinoplasty with excellent results.

Conclusions and Relevance  This alternate technique of costocondral sculpting should be included as an additional tool in the reconstructive surgeon’s armamentarium.

Level of Evidence  NA.

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Figure 1.
Skin Punch Biopsy Instrument in Various Sizes
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Figure 2.
Steps of Carving the Auricular Framework

A, Initial carving of the framework using the skin punch instrument. B, Beginning to create a concave contour of the framework using the skin punch instrument.

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Figure 3.
Contouring the Deep Surface of a Dorsal Onlay Graft
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