Autogenous Costal Cartilage Research Articles

Ear Reconstruction for Auricle Defects Using an Expanded Neck Flap: A Case Report.

This case report describes a patient with a left ear deformity resulting from a flame burn sustained 20 years ago. The patient underwent an ear reconstruction procedure utilizing an expanded neck flap. The autologous rib cartilage was used as the framework, while an expanded neck flap served as the covering for the framework. The surgery was completed in 3 stages. Initially, tissue expanders were implanted and gradually inflated with water. After sufficient expansion, the expanders were removed, and the scar tissue was excised. Subsequently, the expanded flap was used to cover the defects, and the expanded neck flap was rotated to cover the autogenous costal cartilage framework obtained intraoperatively. Finally, the reconstructed ear was repaired by constructing the cephaloauricular sulcus, removing postauricular scars, and trimming the neck-flap pedicle. After a 1-year follow-up, the wound had healed satisfactorily with only minor complications. The shape of the reconstructed ear appeared realistic, and its function was maintained. Most of the scars were repaired, and the scarred alopecia was significantly improved. In patients with limited availability of the postauricular flap, especially burn patients, using an expanded neck flap can lead to superior outcomes.

Relative effects of serratus anterior plane block performed with dexmedetomidine combined with ropivacaine or ropivacaine alone on quality of recovery in children undergoing ear reconstruction

BackgroundDexmedetomidine (Dex) as a local anesthesia adjuvant for nerve block procedures can improve the quality of patient recovery. However, the impact of utilizing Dex as a local anesthetic adjuvant for serratus anterior plane block (SAPB) procedures on recovery quality for children undergoing ear reconstruction remains unclear. MethodsEighty-four patients undergoing ear reconstruction with autogenous costal cartilage (ACC) were randomized into two groups (n = 42/group) in which SAPB was performed with ropivacaine alone (R group) and one in which SAPB was performed with Dex and ropivacaine (DR group). Primary outcomes were patient 15-item quality of recovery (QoR-15) scale scores on days 1 and 2 post-surgery. Secondary outcomes included postoperative rest and coughing numerical rating scale (NRS) chest pain scores, duration of analgesia, oral rescue analgesic usage, and opioid-related side effects. ResultsForty patients per group completed the study. QoR-15 scores on days 1 and 2 post-surgery in the DR group were significantly increased relative to the R group (126.35±9.81 vs 115.53±8.58 and 131.78±8.67 vs 122.80±8.59, all P<0.001). Rest and coughing NRS chest pain scores at 2, 4, 8, 12, and 24h postoperatively in the DR group were all significantly lower relative to the R group (all P<0.05). The DR group also exhibited a significantly longer analgesic duration (P<0.001), and significantly reduced oral rescue analgesic usage and opioid-related side effect incidence (all P<0.05). ConclusionCombining Dex and ropivacaine for SAPB in children undergoing ear reconstruction with ACC can significantly improve quality of recovery, quality of analgesia, and analgesic duration.

Long-term Outcomes on Patients with Microtia after Autogenous Costal Cartilage Reconstruction

Long-term Outcomes on Patients with Microtia after Autogenous Costal Cartilage Reconstruction

Effects of Cutting Planes on Costal Cartilage Warping.

Autogenous costal cartilage becomes a favorable choice for nasal reconstruction and complicated aesthetic rhinoplasty, due to its ample supply, sufficient for most patients. However, a notable drawback is the potential for warping. Our study aims to identify cutting planes that minimize warping. Two hundred and seven costal cartilage grafts were obtained by slicing the extracted costal cartilages from 10 fresh cadavers, along three main planes: cephalocaudal, anteroposterior, and parallel to the synchondrosis plane. Each of these major planes was further divided into grafts taken from both the central and peripheral portions. Furthermore, both subgroups were categorized into three thicknesses: 1mm, 2mm, and 3mm. The warping angles of all grafts were then compared at various time intervals after the initial cutting. Cephalocaudal cuts exhibited significantly greater warping than other planes. Anteroposterior cuts displayed the least warping, although this difference lacked statistical significance. Peak warping occurred at 30 minutes. Certain grafts continued to warp even at 1 month. Central grafts had less warping than peripheral ones, though not statistically significant. Cephalocaudal cuts yielded the highest warping angle. Surgeons seeking thin (< 3 mm) straight grafts should opt for anteroposterior or parallel to synchondrosis planes. Thicker grafts (> 3 mm) can be cut in the cephalocaudal plane with an acceptable warping angle, close to parallel with the synchondrosis plane. For curved cartilage, thin cephalocaudal cut is recommended. Additionally, we suggest placing the cartilage in normal saline for at least 30 minutes, allowing for maximum warping to occur.

Effectiveness of comprehensive rhinoplasty on secondary nasal deformity with saddle nasal deformity after cleft lip surgery

To investigate the effectiveness of comprehensive rhinoplasty with autogenous costal cartilage grafting and prosthesis augmentation rhinoplasty in the treatment of secondary nasal deformity with saddle nasal deformity after cleft lip surgery. The clinical data of 96 patients with secondary nasal deformity with saddle nasal deformity after cleft lip surgery between September 2008 and January 2019 were retrospectively analyzed. There were 17 males and 79 females with an average age of 25.6 years (range, 17-38 years). Autogenous costal cartilage grafts were used to construct stable nasal tip framework and enhance the strength of alar cartilage. Nasal dorsum prostheses (39 cases of bulge, 45 cases of silicone prosthesis) or autogenous costal cartilage (12 cases) were used for comprehensive rhinoplasty. Visual analogue scale (VAS) score was used to evaluate the postoperative satisfaction subjectively, and nasal alar height symmetry index, nasal alar width symmetry index, nasal dorsum central axis deviation angle, and nasal columella deviation angle were calculated to evaluate objectively before and after operation. All patients were followed up 6 months to 8 years, with an average of 13.4 months. Nasal septal hematoma occurred in 3 patients after operation, which was improved after local aspiration and nasal pressure packing. Two cases had mild deformation of the rib cartilage graft of the nasal dorsum, one of which had no obvious deviation of the nasal dorsum and was not given special treatment, and one case underwent the cartilage graft of the nasal dorsum removed and replaced with silicone prosthesis. The incisions of the other patients healed by first intention, and there was no complication such as postoperative infection and prosthesis displacement. The nasal alar height symmetry index, nasal alar width symmetry index, nasal dorsum central axis deviation angle, and nasal columella deviation angle significantly improved after operation when compared with preoperative ones ( P<0.05). Postoperative subjective satisfaction evaluation reached the level of basic satisfaction or above, and most of them were very satisfied. Comprehensive rhinoplasty using autologous rib cartilage grafting to construct a stable nasal tip support, combined with dorsal nasal prosthesis or autologous cartilage implantation, can achieve good effectiveness on secondary nasal deformity with saddle nasal deformity after cleft lip surgery.

New Strategies for Remnant Ear Treatment in Microtia Reconstruction Based on Morphometric Studies.

Given the lack of specific evaluation indices, it is difficult to determine whether to transpose or abandon remnant ears in lobule-type microtia reconstruction. The authors illuminate referable parameters beneficial for proper treatment of remnant ear in an efficient manner. A series of 359 lobule-type microtia patients underwent autogenous costal cartilage auricular reconstruction between 2016 and 2021. Fourteen measuring points and defined distances as well as six ratios of specific distances based on position, plumpness, similarity and the width-to-length ratio of the remnant ear have been described, and relevant tactics for appropriate treatments are introduced. Definite morphometric results contribute to attaining satisfactory contours of reconstructed auricles with harmonious earlobes, which exhibit highly similar dimensions and appearances compared to the contralateral normal ears. With the help of the proposed locating points and measuring approaches, the procedure of remnant ear treatment is systematically clarified. This technique ensures operation safety and contributes to the aesthetic contour of the auricle. IV Laryngoscope, 134:2741-2747, 2024.

Brent Technique of Repair Versus Nagata Auricular Reconstruction for Microtia Reconstruction: A Systematic Review and Meta-Analysis.

Up to 17.4 in every 10,000 births are affected by microtia, but no consensus exists on a gold standard technique for autogenous repair. In this study, the authors compare 2 common methods-the Brent and Nagata autogenous costal cartilage ear reconstruction techniques. A systematic review of the literature and a quantitative meta-analysis to compare the outcomes of these 2 approaches were performed. The outcomes analyzed included rates of infection, necrosis, cartilage exposure, cartilage resorption, hematoma, wire extrusion, and hypertrophic scar. A MEDLINE database systematic review with the following keywords: microtia, Brent, and Nagata was performed. Case reports and articles without original data or patient outcomes were excluded. Inclusion methods for study selection are outlined in Supplemental Digital Content 1, http://links.lww.com/SCS/F461 , below. The prevalence of outcomes for each study was analyzed through meta-analysis of proportions using Stata. A total of 536 potential studies were retrieved for review. Twelve of these studies met inclusion criteria. Four studies utilized the Brent method of repair with the inclusion of 563 ear reconstructions. Nine studies implemented the Nagata technique in 2304 reconstructions. Two studies directly compared the Brent (327 ears) and Nagata (471 ears) techniques. The calculated rate and 95% confidence intervals are summarized in Supplemental Digital Content 2, http://links.lww.com/SCS/F461 . There were no statistically significant differences in complication rates between the Brent and Nagata microtic reconstruction techniques identified in this study. The Brent and Nagata microtia reconstruction techniques have no difference in the risk of infection, necrosis, cartilage exposure, cartilage resorption, hematoma, wire extrusion, or hypertrophic scars.

Total rebuilding of the ear after unsatisfactory initial microtia reconstruction: 30-year experience using autogenous costal cartilage framework

This study describes the author's experience with long-term follow-up analysis of secondary procedures in patients with unsatisfactory initial microtia reconstruction. A total of 134 patients who underwent secondary operations between 1992 and 2021 were reviewed by examining medical records and photographic data. A total of 110 patients followed between 6 months and 26 years (average 33.2 months) were included for evaluation of aesthetic outcomes. Primary reconstruction was performed with costal cartilage in 113 patients, porous polyethylene implant in 7 patients, silicone implant in 6 patients, and others in 8 patients. The major external features at the time of the secondary reconstruction were lump (91 cases), deficient convolution (19 cases), and no framework with scarred mastoid skin (22 cases). All secondary reconstructions were performed with an autogenous costal cartilage framework. The framework was covered using temporoparietal fascia flap techniques in 118 patients, mastoid skin coverage technique in 12 patients, and others in 4 patients. One major complication (exposure of cartilage framework due to partial necrosis of fascial flap) and three minor complications (loss of moderate-sized full-thickness skin, grafted on the fascia) were recorded. The average score given for aesthetic outcomes, rated on a four-point Likert scale (i.e., 1 = poor, 2 = fair, 3 = good, and 4 = excellent) was 3.17 (median 3.00). A total of 42% of the patients were rated excellent and 36% were rated good.

Summary and analysis of total auricle reconstruction in adult microtia patients

Objective: To observe the clinical effect of auricle reconstruction in adult patients with microtia and summarize the experience. Methods: Clinical data of adult patients with microtia who underwent total auricle reconstruction using the modified Nagata's two stage for microtia reconstruction from June 2016 to June 2021 were analyzed. A total of 41 adult patients (42 ears) with microtia were enrolled, including 30 males and 11 females, with the median age at the time of surgery of 37 years. Autogenous costal cartilage was used as the auricular framework for all patients in this group. The first stage surgery was performed according to the modified Nagata's two stage for microtia reconstruction procedure,cartilage auricular framework carving was performed by different methods according to the ossification state of adult costal cartilage. Six months following the primary operation, ear elevation and cranioauricular angle formation, retroauricular facial flap transfer and medium-thick skin grafting were performed in the second stage. Results: All patients successfully completed two stage operation. During the follow-up of 3 months and 24 months, all the 41 patients were satisfied with the morphology of reconstructed auricle. Conclusion: According to the costal cartilage status of adult patients, different costal cartilage carving techniques can be used for total auricle reconstruction to obtain ideal surgical results.

Surgery of Severe Cauliflower Ear Deformity

A cauliflower ear is an auricular deformity characterized by thickened soft tissue and cartilage. A subperichondrial hematoma or fluid collection causes this malformation. As a result of being cut off from the perichondrium blood supply, the ear cartilage becomes ischemic, developing scar tissue, fibrous tissue, new cartilage overgrowth, or necrosis beneath the skin, resulting in a permanent alteration in the shape of the external ear resembling that of a cauliflower. To properly fix defects, the surgeon must grasp ear anatomy and be familiar with a variety of reconstructive alternatives. It requires meticulous attention, due to the intricate design of the ear. Simple and complex techniques for treating cauliflower ears have been developed. However, in severe cases, simple techniques are often insufficient. As a result, complex techniques such as replacement with an auricular prosthesis or implant or autogenous costal cartilage framework were developed. We present a case of a 25-year-old man who experienced a severe cauliflower ear as a result of an infection during adolescence. The patient was concerned about the shape of his ear and was depressed. Ear reconstruction was accomplished using the costal cartilage framework engraved according to a three-dimensional cutting guide for surgical planning. Costal cartilage is chosen to provide a framework for reconstruction as it is strong and rigid, and its curved shape is similar to that of the external ear. There were no complications after surgery. The ear projection and shape have performed admirably. The patient was pleased with the outcome and felt more confident after surgery.

Analysis of the Effect of Autogenous Costal Cartilage Transplantation Combined with Silicone Augmentation Rhinoplasty in Nasal Cosmetic and Plastic Repair

Purpose: To analyze the application value of autogenous costal cartilage transplantation combined with silicone augmentation rhinoplasty. Methods: From January 2022 to January 2023, 84 patients with cosmetic and plastic repair of nose were divided into observation group (44 cases were treated with autogenous costal cartilage transplantation combined with silicone augmentation rhinoplasty) and control group (40 cases were treated with silicone augmentation rhinoplasty) according to the surgical intention of the patients. Compare the difference of prognosis indexes between the two groups after operation, and compare the changes of nasal parameters before and after operation between the two groups, and finally compare the difference of patients' satisfaction between the two groups. Results: ①The 3dVAS score of the observation group was lower than that of the control group (P<0.05), and the wound healing time was shorter than that of the control group (P<0.05); ②The incidence of postoperative complications in the observation group was 4.5%, and that in the control group was 15%. The incidence of postoperative complications in the observation group was lower than that in the control group (P＜0.05); ③There was no significant difference between the two groups (P>0.05) in the angle of nose, the height of nose root and the angle of nose face before operation. The angle of nose tip, the height of nose root and the angle of nose face in the observation group were higher than those in the control group 3 months after operation (P<0.05); ④The satisfaction of the observation group was higher than that of the control group (P<0.05). Conclusion: Autogenous costal cartilage transplantation combined with silicone augmentation rhinoplasty has the advantages of short wound healing time, less postoperative complications and good repair effect, which is helpful to improve the satisfaction of patients and can be widely used.

Strategies for the Treatment of Auricular Complications after the First Stage of Autologous Cartilage Microtia Reconstruction.

Effective handling of auricular complications after the first stage of autologous cartilage microtia reconstruction remains one of the most demanding challenges for plastic surgeons. Here, the authors discuss relevant details for treatment of such complications in various conditions. A total of 1739 microtia patients underwent the first stage of auricular reconstruction with autogenous costal cartilage between 2007 and 2019. Different complications occurred in 136 cases. The details of complications are described, and relevant tactics for appropriate prevention and treatment are introduced. Selective methods for the management of different complications in a prompt and effective manner after the first stage of ear reconstruction have been shown to salvage and maintain the contour of the reconstructed auricle to the maximum extent. Auricular complications can be well treated and prevented through careful preoperative preparation, meticulous intraoperative manipulation, and proper postoperative management. Therapeutic, IV.

Predicting Risk of Infection After Rhinoplasty with Autogenous Costal Cartilage: A Cohort Study.

The study was aimed to develop and validate a nomogram to predict risk of postoperative infection after costal cartilage-based rhinoplasty METHODS: The primary cohort of this study consisted of 672 patients who were appraised between October 2018 and December 2020. The least absolute shrinkage and selection operator (LASSO) regression model was used for data reduction and selection. Multivariable logistic regression analysis was used to develop the predicting model. The calibration curve and C-index were used to evaluate the accuracy of the nomogram, while DCA was used to assess the clinical value. Internal validation was evaluated and an independent validation cohort contained 118 consecutive patients from January 2021 to June 2021. Twenty-one features were reduced to 10 potential predictors on the basis of 672 patients in the primary cohort using LASSO regression. Thus, the predictive nomogram finally contained ten clinical features-age, number of nose operations, length of hospital stay, operation time, history of nose trauma, history of animal contact after operation, smoking after operation in one month, drinking after operation in one month, history of nose infection, and spicy food after operation in one month with the most essential factor. The model showed good discrimination with a C-index of 0.987 (95% CI, 0.978-0.996) (internal validation of 0.967) and good calibration. In addition, the model also had the highest sensitivity due to the AUC of the model was 0.987. Application of the nomogram in the validation cohort still gave good discrimination (C-index, 0.935 [95% CI, 0.910-0.960]). Decision curve analysis demonstrated that the nomogram was clinically helpful. This is the first study to develop a nomogram to predict infection after rhinoplasty with autologous costal cartilage. Use of this nomogram might help surgeons with early identification of patients at high risk of infection. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Novel method for high-density porous polyethylene ear reconstruction stent remodeling to achieve high satisfactory outcomes.

We aimed to explore a novel method for ear reconstruction stent remodeling to achieve high patient satisfactory outcomes. This study is a retrospective review of patients with congenital or acquired ear defects who were prepared for one-stage ear reconstruction with high-density porous polyethylene stent between May 2020 and May 2021. A standardized data collection template was used to collect related variables. In this study, the detailed reconstruction surgery process is carefully described, and the postoperative healing process of the ear reconstruction was closely observed. A total of 26 patients for one-stage ear reconstruction with high-density porous polyethylene stent or autogenous costal cartilage scaffolds were admitted to the department of plastic surgery in our hospital between May 2020 and May 2021. All patients were followed until their ear flaps were alive and details of the ear shape were revealed. The patients with new remolding method were no severe complications and only a patient had stent exposure, and were highly satisfied with both appearance and function. The application of novel remodeling method is a promising way for ear reconstruction stent shaping with little postoperative complication and excellent postoperative patient satisfaction.

Clinical Application of Carving Template With 3D Reconstruction Technique for Personalized and Precise Treatment of Traumatic Ear Defects.

We explored the clinical application of a 3-dimensional (3D) digital reconstruction technique for personalized and precise traumatic ear defect treatment. A 3D scanner was used to obtain 3D images of the unaffected ear. The data were converted into an ear contour model through mirroring using the software, and imported to a rapid prototyping 3D printer to construct an ipsilateral ear model. For treating different types of ear defect patients with individualized treatment programs, the defective ear model was constructed with individualized autogenous costal cartilage carving. We constructed ipsilateral ear defect models in 16 cases and rebuilt the auricular with >10 outer ear substructure units, maintaining a stable cranial angle. At the 6-month follow-up, the reconstructed ear was similar to the unaffected one, and the patient satisfaction was high. Based on a paired t test, the differences in the width of both auricles was statistically significant, with P values of 0.023, respectively. The differences in the P values of the auricle length, circumference and height, at 0.261, 0.333, and 0.197, respectively, were not statistically significant. Compared to the model utilizing the traditional 2D film template of the ear, the 3D reconstruction technology was more intuitive and stereoscopic, and the personalized ear reconstruction was accurate. Thus, 3D digital technology can avail the most suitable personalized treatment for various traumatic ear defects. It can assist in precisely engraving the reconstructed cartilage stent and objectively analyzing the postoperative results. The therapeutic effect was significant.

Clinical application of the 6th autogenous costal cartilage in the treatment of severe saddle nose deformity after trauma.

Saddle nose deformity is a common clinical nose deformity. This study aimed to evaluate the effectiveness of the 6th autogenous costal cartilage in the treatment of severe saddle nose deformity after trauma. A retrospective analysis was conducted on 15 patients with severe post-traumatic saddle nose deformity from March, 2016 to March, 2019. The nasal tip and dorsum were reconstructed with autogenous costal cartilage. All patients were followed up for 6 to 13 months and changes in nasal appearance were evaluated. The changes in dorsum sag, nasolabial angle, nasal dorsal angle, and dorsum length were measured. Fourteen patients were basically satisfied with post-operative outcome. Only one patient developed infection afterwards, which was improved by the revised rhinoplasty 2 months after active treatment. The immediate nasal dorsal depression [(1.19±0.94) mm] and nasolabial angle [(94.06±1.52)°] after operation decreased compared with those before surgery [(8.28±0.24) mm, (109.42±2.78)°, respectively; all P<0.05]. The immediate nasal dorsal length [(44.18±1.02) mm] and nasal dorsal angle [(132.84±2.33)°] increased compared with those before operation [(31.73±1.86) mm, (122.87±2.42)°, respectively; all P<0.05]. The data at follow-ups showed no statistical difference compared with the immediate data after operation. Rhinoplasty with the 6th autogenous costal cartilage is an effective method for the correction of severe saddle nose deformity after trauma.

Технология дополненной реальности для реконструкции ушной раковины при лечении микротии

Facial defects and deformations occupy a significant place in the practice of maxillofacial and dental surgeons. Nevertheless, maxillofacial surgery is developing rapidly and requires improvement of existing treatment methods, and introduction of new approaches to reconstructive surgery. Augmented reality is a promising direction of computer technology development which is actively used in medicine and education. Modern computer technology allows to create a 3D model of a lost organ and use it for preoperative planning, as well as apply a virtual model for intraoperative navigation. Recently, the method of augmented reality has been actively developed, when a virtual image of the zone of the surgical area or a dedicated organ is used, which is compared with its real prototype in static mode, or in real-time using computer devices. The benefits of using augmented reality technologies in reconstructive surgery is associated with preoperative virtual planning, simplification of the surgical intervention itself, as well as with a reduction in the risks of intra- and postoperative complications. The aim of our work was to study the opportunity of using the augmented reality technology in reconstructive surgery for microtia correction based on pre-operative computer simulation. At the preoperative stage, a photometric analysis of the patient was carried out, then a computer simulation of the missing auricle was performed. Using a 3D printer, a virtual model of the reconstructed auricle was obtained. The image in three-dimensional format was loaded into augmented reality glasses, which made it possible to project the shape and position of the simulated auricle to the area of the defect of the auricle when preparing for surgery. During the surgery, a marker was installed near the surgical field, in order to display the three-dimensional model in a destined position. During surgical intervention, an autogenous costal cartilage was taken, from which the auricle was formed using augmented reality approach and three-dimensional modeling. Subsequently, the graft was introduced to the formed bed in the area of the right ear auricle. The obtained 3D model of the auricle before the operation enabled planning of the forthcoming operation and determine the amount of autograft needed for reconstruction. Using the augmented reality glasses, the exact shape of the auricle is reproduced during the operation, and its proper position is assessed in relation to the healthy side. No complications were observed over the postoperative period. Virtual modelling of a lost or absent organ based on a preoperative examination provides important information about its spatial structure. Preoperative virtual planning allows you to predict the individual features of the operation, its difficult stages, to anticipate possible complications. The use of augmented reality technology during reconstructive surgery is a promising method requiring further development and improvement.

Use of Autologous Costal Cartilage Combined with Expanded Polytetrafluoroethylene in Asian Rhinoplasty

ABSTRACT Background The corresponding author's experience and recent methods employed in autologous costal cartilage grafts combined with expanded polytetrafluoroethylene (ePTFE) in Asian rhinoplasty were presented in this study. Objectives The purpose of this study was to assess the outcomes of rhinoplasty performed on patients using autogenous costal cartilage grafts combined with an ePTFE implant. Methods Seventy-five rhinoplasty cases with autologous costal cartilage grafts and an ePTFE implant were retrospectively reviewed. Graft types, complications associated with the graft itself or graft harvesting, surgical outcomes, and patient satisfaction were assessed. Results The mean follow-up time post-operation was 13.5 months. A total of 42/75 patients underwent revision surgeries. Graft-related complications were found in 8% of cases, including two warped graft and four infection cases. Three individuals with infections had mild graft resorption. One patient with an infection removed the implant. Graft exposure, mobility, and substantial resorption were not recorded. A total of two cases underwent revision procedures for infection and perforation, respectively. Chest incision lengths for graft harvesting averaged 2.1 cm. No pneumothorax or significant donor-site pain was found. Donor-site scars were negligible, although two cases had hypertrophic chest scars. In general, functional and esthetic outcomes were mostly satisfactory among the assessed patients. Conclusions Rhinoplasty using autologous rib cartilage provides adequate support and sufficient cartilage amounts for correcting nasal contouring. Meanwhile, ePTFE alone for nasal dorsum augmentation safely achieves satisfactory outcomes. Rib cartilage rhinoplasty performed by an experienced surgeon yields excellent, long-lasting results with minimal risk; however, the potential for infection should be considered following revision surgery.

Prevention of Autologous Costal Cartilage Graft Warping in Secondary Rhinoplasty.

Autogenous costal cartilage grafts (ACCG) are frequently used in secondary rhinoplasty; however, these grafts tend to warp. The objective of this study is to systematically evaluate current interventions to prevent warping of ACCGs and to assess long-term outcomes with their use. A systematic review was undertaken using a computerized search. Eligible articles assessed adult patients undergoing secondary rhinoplasty with ACCGs. Interventions to reduce warping were examined. Publication descriptors were extracted, heterogeneity was examined, and methodological quality of articles was assessed. Eighteen studies were included. Most studies were published after 2010 (83.3%), assessed a single intervention (83.3%), and were of levels of evidence III and IV. Mean patient age was 30 (range 5-95 years) and studies included a mean of 64 cases (range 9-357). Nine of the 15 non-comparative studies were considered of high methodological quality, while all 3 comparative studies were considered high quality. Secondary rhinoplasties which did not describe a method to address warping showed increased rates of warping compared to counter balancing techniques, chimeric grafts, titanium microplating, Kirschner wire and suture usage, irradiation, and various carving techniques. Rates of warping remained low with no major complications with the use of a variety of approaches. ACCG warping during secondary rhinoplasty can be alleviated with a variety of techniques with no clear difference in outcomes between approaches. Plastic surgeons may consider adopting one of the various techniques described in order to reduce warping, maximize aesthetic outcomes and patient satisfaction.

Simultaneous Correction of Complex Secondary Deformities of Cleft Lip Using Autogenous Costal Cartilage Combined With Rib Grafts.

Complex secondary deformities of cleft lip include nasal and labial deformities, alveolar cleft, oronasal fistula, and so on. In this report, the authors present a method to simultaneously repair the above complex deformities with autogenous costal cartilage and rib grafts. The surgical procedure of simultaneous correction includes RESULTS:: Satisfactory outcomes were achieved in all 22 patients. Fifteen patients were followed up for 6 to 24 months and exhibited good nasal shape, repaired alveolar cleft, improved labial shape, and closed oronasal fistula. Three patients presented with red nasal tips. One patient had local infection, which was cured by antibiotics. This methodAs this method has led to positive outcomes, it has the potential to be widely used in clinical practice.