Abstract
We describe the endoscopic-assisted rib harvesting technique for secondary rhinoplasty as minimum - invasive and safe harvesting method. Endoscopic-assisted rib harvesting was performed on 52 patients for revision rhinoplasty in last two years (2017-2019). Adequate amount of cartilage was obtained through 1-2 cm incision. The 30 degrees angled endoscope was used for vision control. Fifty-two patients underwent rhinoplasty with costal cartilage harvested using endoscopic-assisted method. The length of the harvested cartilage blocks from the rib was 5 ± 1.5 cm in average. There were no associated intraoperative complications. Postoperative complications were less than by the conventional rib harvesting technique: in all cases, no signs of pneumothorax or excessive bleeding were detected after surgery. The wound healed without significant scarring in 50 (96%) cases. Two patients (4%) showed hypertrophic scar formation. Postoperative pain was evaluated by using Visual Pain Analog Scale retrospectively. Forty-eight patients (92%) scored 1.43 ± 0.7 experienced no significant postoperative pain. Only 4 patients (8%) scored 4.1 ± 0.8 and complained of slight postoperative pain. This technique provides an effective and less-invasive alternative for conventional costal cartilage harvesting with reduced complications risk and extended visualization. Patients benefit from an inconspicuous scar and reduced postoperative pain. Technique can be applied for revision and primary rhinoplasty and allows achieving reproducible aesthetically and functionally successful results with minimized risks.
Highlights
Nasal framework reconstruction in secondary and more rarely in primary rhinoplasty is often restricted by quantity and quality of cartilaginous framework
The most commonly used donor site for cartilage harvesting is considered to be septal cartilage, surgeons frequently face such problems as: paucity of available graft material, especially in secondary cases and cartilaginous insufficiency in severe deformities cases. Both arguments are true in secondary rhinoplasty when over resection of the osseocartilaginous framework is observed
With regard to above mentioned complexities, we suggest the method of endoscope-assisted rib cartilage harvesting
Summary
Nasal framework reconstruction in secondary and more rarely in primary rhinoplasty is often restricted by quantity and quality of cartilaginous framework. From all potential donor sites for autologous graft, the rib provides the most abundant cartilage source for graft fabrication and is the material of choice when reliable support is required[1]. Conventional rib harvesting techniques included 3-5 cm incision and cutting the muscles[2]. Autogenous graft harvesting is associated with several disadvantages such as postoperative pain, visible scar, risk of pleura perforation and often requires advanced surgical skills[3,4].
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