Single centre review of the use of costal cartilage for reconstruction of the nasal dorsum
- 24 Downloads
Reconstruction of the nasal skeleton aims to allow optimal air passage as well as a cosmetically pleasing appearance. Autogenous graft materials are the gold standard due to low extrusion and infection rates. A larger source of cartilage is required for complex secondary nasal reconstruction which makes costal cartilage an ideal source of autogenous material.
We performed a retrospective review of all patients undergoing nasal reconstruction with autogenous costal cartilage between the years 2005 to 2016. All procedures were performed by a single surgeon across two hospital sites. Patient charts were reviewed to determine aetiology, indication for surgery, referral source, post-operative complications, need for revision surgery and the length of follow-up.
There was a total of 28 patients, 68% male with an average age of 37 years. The majority were referred from ENT (50%) followed by plastic or maxillofacial surgeons (21%). The commonest indication for surgery was previous nasal trauma (53%), and 88% of patients with trauma as the aetiology had previous nasal surgery prior to costal cartilage reconstruction. The commonest complication was warping of the costal cartilage graft; this occurred in 18% of patients; a slipped costal cartilage graft occurred in 4%. The revision rate was 32%. There were no cases of pneumothorax, pleural tear and post-operative infection.
Despite the availability of alternative cartilage sources and the risk of cartilage warping, autogenous costal cartilage is still the ideal cartilage source for complex nasal reconstruction. It is readily available, durable and versatile. Several recent studies have reported alterations in surgical technique to reduce warping. This will subsequently reduce rates of revision surgery and ensure this versatile cartilage source continues to be utilised by surgeons in future.
Level of Evidence: Level IV, therapeutic study
KeywordsCostal cartilage Septorhinoplasty Dorsal reconstruction Costal graft Warping Rhinoplasty
Compliance with ethical standards
No funding was received for any part of this study.
Conflict of interest
Serena Martin, Michael McBride, Robbie Stewart, Greg McBride, and Chris Hill declare that they have no conflicts of interest.
Ethical approval was not required for this study.
Informed consent was obtained from all individual participants included in the study. Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.