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Original Investigation |

Reconstructive Rhinoplasty Using Multiplanar Carved Costal Cartilage

Michael J. Nuara, MD1,2; Randall B. Loch, MD2; Sarah A. Saxon, MD2,3
[+] Author Affiliations
1Department of Facial Plastic Surgery, Virginia Mason Medical Center, Seattle, Washington
2Division of Otolaryngology–Head and Neck Surgery, University of New Mexico, Albuquerque
3Department of Otolaryngology, University of Texas Southwestern, Dallas
JAMA Facial Plast Surg. 2016;18(3):207-211. doi:10.1001/jamafacial.2015.2251.
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Importance  Reconstructive rhinoplasty often requires the use of cartilage grafts. Full-thickness autologous costal cartilage grafts provide a large amount of cartilage in a single uncarved block and are often used for major reconstructions. Warping is frequently described as a complication of rib cartilage use in rhinoplasty.

Objective  To describe an approach to cartilage carving whereby a single block of cartilage is carved in a multiplanar manner to mimic or redefine the anatomic relationships and resist warping.

Design, Setting, and Participants  A retrospective review of reconstructive rhinoplasty cases using multiplanar costal cartilage grafting technique was performed. A consecutive sample of 11 patients with complex nasal deformity underwent reconstruction with an autologous costal cartilage block carved in 3 dimensions to address complex deformities at the University of New Mexico Hospital between January 2010 and December 2014. The follow-up period ranged from 3 to 36 months.

Interventions  Autologous rib cartilage harvest was performed to obtain a full-thickness segment of rib cartilage. The deficient or malformed nasal cartilage is defined and soft tissue prepared using an open rhinoplasty approach. Rib cartilage graft curvature is removed to create a uniform, symmetric, solid block of cartilage. A cartilage graft is carved in a multiplanar fashion to simulate normal nasal anatomy.

Main Outcomes and Measures  Postoperative evaluation of nasal airway function, cartilage graft warping, and aesthetic outcomes were reported in the follow-up period. Nasal Obstructive Symptom Evaluation (NOSE) scores are documented in the majority of cases and were obtained at least 3 months postoperatively.

Results  Overall, 11 patients with complex nasal deformity underwent reconstruction with an autologous costal cartilage block carved in 3 dimensions. The most common use was for reconstruction of the septum with the upper lateral cartilage. There were no major complications. No patients experienced graft warping in the follow-up period. Several patients required minor revision procedures. All patients reported improved nasal airway and improved aesthetic appearance of the nose.

Conclusions and Relevance  Multiplanar costal cartilage grafting is a useful surgical technique for complex reconstructive rhinoplasty that yields optimal and predictable results.

Level of Evidence  4.

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Figure 1.
Creating the Multiplanar Costal Cartilage Graft

A, A full-thickness segment of rib cartilage is harvested, and (B) the autologous costal cartilage block carved in 3 dimensions. C, After completed, the construct will be submerged in a saline bath.

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Figure 2.
Clinical Images and Placement of Multiplanar Costal Cartilage Graft

A and B, Photographs of the lateral view and anterior view of the constructed cartilage graft. C, Photograph of the intraoperative placement of the cartilage graft.

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Figure 3.
Results of Reconstructive Rhinoplasty Using Multiplanar Costal Cartilage Grafting

A, Photograph of a patient prior to undergoing reconstructive rhinoplasty using multiplanar costal cartilage grafting; (B) intraoperative photograph of the cartilage graft; and (C) a postoperative photograph of the patient demonstrating improved nasal airway and improved aesthetic appearance of the nose.

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Figure 4.
Results of Reconstructive Rhinoplasty Using Multiplanar Costal Cartilage Grafting

A, Photographs of a patient prior to undergoing reconstructive rhinoplasty using multiplanar costal cartilage grafting, and (B) postoperative photographs of the patient demonstrating improved nasal airway and improved aesthetic appearance of the nose.

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