Osseocartilaginous Rib Graft Rhinoplasty: A Stable, Predictable Technique for Major Dorsal Reconstruction
Christophel JJ, Hilger PA. Division of Facial Plastic Surgery, University of Virginia Health System, Charlottesville (Dr Christophel), and Otolaryngology Department, University of Minnesota, Minneapolis (Dr Hilger). Arch Facial Plast Surg. 2010 Nov 15 [Epub ahead of print]
Objective To assess the long-term stability of osseocartilaginous dorsal onlay rib grafts used for augmentation rhinoplasty. Methods Patients who had rib grafts used for augmentation rhinoplasty from 2000 through 2009 were assessed for graft viability, graft mobility, graft warping, maintenance of dorsal projection, functional airway status, need for revision surgery, and donor site morbidity. A retrospective cohort study using telephone follow-up was conducted. Results A total of 58 rib graft rhinoplasties were performed in the 10-year review period, 39 of which used dorsal onlay grafts. The mean duration of clinical follow-up was 24 months, and the median duration of clinical follow-up was 16 months. Thirty-three of 33 osseocartilaginous onlay grafts (100%) and 5 of 6 cartilaginous onlay grafts (83%) were viable, rigid, and had maintained dorsal projection at last follow-up. None of the grafts warped. Twenty-nine of 33 patients receiving osseocartilaginous onlay grafts (88%) and 5 of 6 patients receiving cartilaginous onlay grafts (83%) had persisting relief of their nasal obstruction. Twelve of the 39 patients (30%) had revision surgery, mostly performed for minor cosmetic revision. Conclusions Osseocartilaginous onlay rib grafts provide an ideal scaffold for dorsal nasal augmentation and restoration of nasal airway in patients with collapse of the nasal framework due to a saddle deformity, history of trauma, or history of multiple septorhinoplasties. The graft has excellent viability, lacks potential for long-term warping, achieves bony fusion to the nasal bones, and allows surgical molding of the cartilaginous tip.