Rib Grafting In Rhinoplasty

Abstract

Autologous costal cartilage grafting (ACCG) is the workhorse grafting material in rhinoplasty, especially in post-traumatic and cartilage-depleted revision cases. Although the donor- and recipent-site morbidities have been criticized extensively for many years, refined and improved surgical techniques, novel approaches, and updates in management lowered the complication rates. With careful preoperative planning and meticulous surgical techniques, ACCG will yield predictable and satisfying outcomes. ACCG is an outstanding grafting material for every rhinoplasty surgeon’s armamentarium. Its strength and abundance allows durable reconstruction of the nose with an appropriate structural support and versatility. Irradiated homologous costal cartilage (IHCC) graft also presents as a good alternative when donor-site morbidity has to be avoided. ACCG indications have a wide range: saddle nose deformity (SND) following trauma, revision, and ethnic (Asian) rhinoplasty cases; reconstructions following removal of neoplastic malignancies; and congenital deformities that require abundant augmentation and structural cartilage grafting. Alloplastic materials have been extensively studied in the literature, and ACCG is generally preferred over alloplastic materials mainly due to lower extrusion, displacement, and infection rates. Whenever this is the case––especially in secondary and tertiary cases––the costal cartilage offers ample material with strength that allows reconstruction with adequate structural support and versatility. Hence, the surgeons should have a low threshold for ACCG as the outstanding versatile grafting material of choice. This chapter summarizes all aspects of costal grafting from harvesting to associated possible complications and their management.