Rib Cartilage Grafting For Revision Rhinoplasties
The nose possesses extremely delicate anatomy which is responsible for its shape, proportions, and position. To reconstruct this anatomy accurately, in some cases it may be necessary to resort to cartilage grafts obtained from the ribs. In this article, we will see why the rib is chosen as a source of grafts, what advantages it has, how it is used and what complications may arise.
Why are rib grafts used in some secondary rhinoplasty cases?
The use of grafts is usually necessary for patients with a history of unsatisfactory rhinoplasties or previous trauma. This is because revision patients typically need to add volume to their nose in order to supplement or replace the anatomical structures that have been damaged. The problem is that in order to do this, a large amount of cartilage is necessary.
Under normal conditions, the nasal septum and ears offer sufficient quantity and quality of cartilage to meet the needs of a typical secondary rhinoplasty. Both structures offer between 2 and 4 cm2 of useful surface that is usually enough to make partial corrections in the tip and/or the nasal dorsum. However, there are some special conditions in which other sources of cartilage must be used:
- Severe anatomical and/or cicatricial alterations.
- Nasal septum and auricular cartilage lesion.
- Large amounts of cartilage (more than 4 cm2) are required.
- Soft tissue segments such as the fascia or perichondrium of the cartilage are required.
What are the advantages of using rib grafts in secondary rhinoplasty?
The fundamental benefits of using the rib as a source of cartilage grafts are the following:
- Availability of strong and easily carved cartilage.
- The possibility of obtaining grafts of different shape: Laminate, curved, fine or thick.
- The possibility of obtaining large segments of perichondrium or fascia without having to resort to additional sources.
- Reconstruct the alar cartilages in their entirety, generating a totally new tip in shape and position.
- Rebuild external and internal valves to improve nasal obstructions.
- Reconstruct the back of the nose in cases of deformity.
- Reconstruct the septal septa in cases of perforation.
How are rib grafts obtained?
During rhinoplasty, only the cartilaginous portion of the rib is used. The cartilaginous segment of each rib is relatively small and is located in the area closest to the sternum. The incision needed to access the cartilaginous portion of the chosen rib is approximately 2 to 3.5 cm and should be made under the breast fold in women or on the rib chosen in men. Although the needs are usually very varied, in the case of a secondary rhinoplasty michigan, it is usually sufficient to obtain a fragment of about 3.5 cm in length from the 6th, 7th or 8th rib. In addition to the rib segment, a fragment of muscular fascia and a segment of the perichondrium covering the rib are also extracted.
The selected rib fragment cannot be used as it is obtained since it is too thick and curved. After the cartilage is removed, the next step is to carve it to obtain the grafts. The carving of the cartilage must be very precise as they will create the shape of the nose. Once the grafts have been put in place, the fascia and perichondrium are used to cover them so that they are not noticed after healing.
What are the possible complications of rib grafts?
The complications that can appear as a result of the use of rib grafts during rhinoplasty do not differ from those that can appear with other types of fat grafts. During the extraction of the rib, it is important to be careful to avoid inadvertent perforations of the pleura that can cause a pulmonary collapse. Infections or bruising are extremely rare if appropriate measures are taken.
Given the structural characteristics of the rib cartilage, it is very important to carve them very precisely, following established standards. A proper and meticulous carving reduces the likelihood of unwanted deformities, which can be caused if the cartilage is curved after the intervention. If the carving is done properly you can get extremely straight and strong fragments that do not bend over time.
The fragments obtained in which there is a tendency to bend can be used to reconstruct structures that need “curves” in their original form (such as the alar cartilages). As with any other type of graft, it is always appropriate to hide them when possible and cover them with fascia or perichondrium. All these measures are aimed at preventing grafts from being noticed.
What is the postoperative period like?
The postoperative evolution of secondary rhinoplasties performed with rib grafts is not longer or more complicated, although greater supervision is recommended. Scarring and deposits of fibrosis are the main events that should be monitored in the medium and long term.
Many people believe that the postoperative period of this surgery is very painful, however, that is not true. Your doctor will provide you with the necessary analgesics to help you feel comfortable and avoid any pain. Once discharged, you must get the proper rest and avoid any kind of stress or pressure in the area where the rib graft was removed.