Skip to main content
SpringerLink
Log in

Costal Cartilage Grafting for Dorsal Augmentation

  • Chapter
  • First Online:
Advanced Aesthetic Rhinoplasty

Abstract

The aesthetic and functional implications of an appropriate dorsal contour are immense and contribute significantly to the overall rhinoplasty results. The authors discuss anatomy of the upper, middle, and lower thirds of the nose, goals for augmentation, materials used for dorsal augmentation, evaluation of the patient, harvesting the grafts, determining the needs of the dorsum with contour deformity, contour deformity with middle nasal vault collapse, contour deformities with significant loss of structural support, and defects encompassing the bony dorsum. Augmentation and reconstruction of the nasal dorsum is a challenging component of rhinoplasty. The role of the middle nasal vault in function and aesthetics is vital, and maintenance of the support mechanisms is paramount to the ideal dorsal profile. The interplay between the nasal pyramid, cartilaginous septum and upper lateral cartilages, and lower third of the nose must be taken into consideration during reconstruction.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 229.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 299.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 299.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Orten SS, Hilger PA (2008) Facial analysis of the rhinoplasty patient. In: Papel ID, Holt GR, Frodel GL, Larrabee WF Jr, Nachlas NE (eds) Facial plastic and reconstructive surgery, 3rd edn. Thieme Medical Publishing, New York, pp 361–368

    Google Scholar 

  2. Kim I, Chung Y, Lee Y (2008) An anatomic study on the overlap patterns of structural components in the keystone area in noses of Koreans. Clin Exp Otorhinolaryngol 1(3):158–160

    Article  PubMed  Google Scholar 

  3. Pribitkin EA, Ezzat WH (2009) Classification and treatment of the saddle nose deformity. Otolaryngol Clin North Am 42(3):437–461

    Article  PubMed  Google Scholar 

  4. Kim DW, Mau T (2006) Surgical anatomy of the nose. In: Bailey B, Johnson J, Newlands S (eds) Head and neck surgery – otolaryngology, 4th edn. Lippincott Williams & Wilkins, Philadelphia, pp 2511–2532

    Google Scholar 

  5. Tardy ME, Schwartz M, Parras G (1989) Saddle nose deformity: autogenous graft repair. Facial Plast Surg 6(2):121–134

    Article  PubMed  Google Scholar 

  6. Lupo G (1997) The history of aesthetic rhinoplasty: special emphasis on the saddle nose. Aesthetic Plast Surg 21(5):309–327

    Article  PubMed  CAS  Google Scholar 

  7. Adamson PA (1995) The over-resected nasal dorsum. Facial Plast Surg Clin North Am 3:407–419

    Google Scholar 

  8. Romo T 3rd, Kwak ES (2006) Nasal grafts and implants in revision rhinoplasty. Facial Plast Surg Clin North Am 14(4):373–387

    Article  PubMed  Google Scholar 

  9. Tham C, Lai YL, Wend CJ, Chen YR (2005) Silicone augmentation rhinoplasty in an oriental population. Ann Plast Surg 54(1):1–5

    Article  PubMed  CAS  Google Scholar 

  10. Turegun M, Sengezer M, Guler M (1998) Reconstruction of saddle nose deformities using porous polyethylene implant. Aesthetic Plast Surg 22(1):38–41

    Article  PubMed  CAS  Google Scholar 

  11. Adams JS (1987) Grafts and implants in nasal and chin augmentation A rational approach to material selection. Otolaryngol Clin North Am 20(4):913–930

    PubMed  CAS  Google Scholar 

  12. Sclafani A, Thomas J, Cox A, Cooper MH (1997) Clinical and histologic response of subcutaneous expanded polytetrafluoroethylene (Gore-Tex) and porous high-density polyethylene (Medpor) implants to acute and early infection. Arch Otolaryngol Head Neck Surg 123(3):328–336

    Article  PubMed  CAS  Google Scholar 

  13. Kridel RW, Konior RJ (1993) Irradiated cartilage grafts in the nose: a preliminary report. Arch Otolaryngol Head Neck Surg 119(1):24–31

    Article  PubMed  CAS  Google Scholar 

  14. Gunter JP, Clark CP, Robinson JB (1999) The rate of warping in irradiated and nonirradiated homograft rib cartilage: a controlled comparison and clinical implications. Plast Reconstr Surg 103(1):265–270

    Article  PubMed  Google Scholar 

  15. Welling DB, Maves MD, Schuller DE, Bardach J (1988) Irradiated homologous cartilage grafts. Long-term results. Arch Otolaryngol Head Neck Surg 114(3):291–295

    Article  PubMed  CAS  Google Scholar 

  16. Donald PJ (1986) Cartilage grafting in facial reconstruction with special consideration of irradiated grafts. Laryngoscope 96(7):786–807

    PubMed  CAS  Google Scholar 

  17. Kridel RWH, Ashoori F, Liu ES, Hart CG (2009) Long-term use and follow-up of irradiated homologous costal cartilage grafts in the nose. Arch Facial Plast Surg 11(6):378–394

    PubMed  Google Scholar 

  18. Sclafani AP, Romo T, Jacono AA, McCormick SA, Cocker R, Parker A (2001) Evaluation of acellular dermal graft (AlloDerm) sheet for soft tissue augmentation: a 1-year follow-up of clinical observations and histological findings. Arch Facial Plast Surg 3(2):101–103

    Article  PubMed  CAS  Google Scholar 

  19. Gunter JP, Rohrich RJ (1990) Augmentation rhinoplasty: dorsal onlay grafting using shaped autogenous septal cartilage. Plast Reconstr Surg 86(1):39–45

    Article  PubMed  CAS  Google Scholar 

  20. Dyer WK, Beaty MM, Prabhat A (1999) Architectural deficiencies of the nose: treatment of the saddle nose and short nose deformities. Otolaryngol Clin North Am 32(1):89–112

    Article  PubMed  Google Scholar 

  21. Marin VP, Landecker A, Gunter JP (2008) Harvesting rib cartilage grafts for secondary rhinoplasty. Plast Reconstr Surg 121(4):1442–1448

    Article  PubMed  CAS  Google Scholar 

  22. Chait LA, Becker H, Cort A (1980) The versatile costal osteochondrial graft in nasal reconstruction. Br J Plast Surg 33(2):179–184

    Article  PubMed  CAS  Google Scholar 

  23. Gibson T (1957–1958) The distortion of autogenous cartilage grafts: its cause and prevention. Br J Plast Surg 10:257–274

    Article  Google Scholar 

  24. Gunter JP, Clark CP, Friedman RM (1997) Internal stabilization of autogenous rib cartilage grafts in rhinoplasty: a barrier to cartilage warping. Plast Reconstr Surg 100(1):161–169

    Article  PubMed  CAS  Google Scholar 

  25. Gunter J, Cochran C, Marin V (2008) Dorsal augmentation with autogenous rib cartilage. Semin Plast Surg 22(2):74–89

    Article  PubMed  Google Scholar 

  26. Abrahams M, Duggan TC (1964) The mechanical characteristics of costal cartilage. In: Kenedi RM (ed) Biomechanics and related bioengineering topics: proceedings of symposium held in Glasgow. Pergamon Press, New York, p 196

    Google Scholar 

  27. Adams WP, Rohrich RJ, Gunter JP, Clark CP, Robinson JB (1999) The rate of warping in irradiated and nonirradiated homograft rib cartilage: a controlled comparison and clinical implications. Plast Reconstr Surg 103(1):265–270

    Article  PubMed  Google Scholar 

  28. Harris S, Pan Y, Peterson R, Stal S, Spira M (1993) Cartilage warping: an experimental model. Plast Reconstr Surg 92(5):912–915

    PubMed  CAS  Google Scholar 

  29. Kim DW, Shah AR, Toriumi DM (2006) Concentric and eccentric carved costal cartilage: a comparison of warping. Arch Facial Plast Surg 8(1):42–46

    Article  PubMed  Google Scholar 

  30. Chase SW, Herndon CH (1955) The fate of autogenous and homogenous bone grafts. J Bone Joint Surg Am 37-A(4):809–841

    PubMed  CAS  Google Scholar 

  31. Mowlem R (1963) Bone grafting. Br J Plast Surg 16:293–304

    Article  PubMed  CAS  Google Scholar 

  32. Shipchandler TZ, Chung BJ, Alam DS (2008) Saddle nose deformity reconstruction with a split calvarial bone L-shaped strut. Arch Facial Plast Surg 10(5):305–311

    PubMed  Google Scholar 

  33. Christophel JJ, Hilger PA (2011) Osseocartilaginous rib graft rhinoplasty: a stable, predictable technique for major dorsal reconstruction. Arch Facial Plast Surg 13(2):78–83

    PubMed  Google Scholar 

  34. Bilen BT, Kilinc H (2007) Reconstruction of saddle nose deformity with three-dimensional costal cartilage graft. J Craniofac Surg 18(3):511–515

    Article  PubMed  Google Scholar 

  35. Kalogjera L, Bedekovic V, Baudoin T, Ivkic M (2003) Modified alar swing procedure in saddle nose correction. Aesthetic Plast Surg 27(3):209–212

    Article  PubMed  Google Scholar 

  36. Yabe T, Muraoka M (2004) Treatment of saddle type nasal fracture using Kirschner wire fixation of nasal septum. Ann Plast Surg 53(1):89–92

    Article  PubMed  Google Scholar 

  37. Beekhuis GJ (1974) Saddle nose deformity: etiology, prevention, and treatment; augmentation rhinoplasty with polyamide. Laryngoscope 84(1):2–42

    Article  PubMed  CAS  Google Scholar 

  38. Andrade M, Fernandes VS, Boleo-Tome JP (1999) Saddle nose: our approach to the problem. Aesthetic Plast Surg 23(6):403–406

    Article  PubMed  CAS  Google Scholar 

  39. Merkonidis C, Verma S, Salam MA (2005) Saddle nose deformity in a patient with Crohn’s disease. J Laryngol Otol 119(7):573–576

    PubMed  CAS  Google Scholar 

  40. Shine NP, Hamilton S, McShane DP (2006) Takayasu’s arteritis and saddle nose deformity: a new association. J Laryngol Otol 120(1):59–62

    PubMed  Google Scholar 

  41. Congdon D, Sherris DA, Specks U, McDonald T (2002) Long-term follow-up of repair of external nasal deformities in patients with Wegener’s granulomatosis. Laryngoscope 112(4):731–737

    Article  PubMed  Google Scholar 

  42. Vogt PM, Gohritz A, Haubitz M, Steiert A (2010) Reconstruction of nasal deformity in Wegener’s granulomatosis: contraindication or benefit? Aesthetic Plast Surg 35(2):156–161

    Article  PubMed  Google Scholar 

  43. Malaviya GN, Husain S (1994) Surgical correction of saddle nose deformity in leprosy – one stage procedure. Acta Leprol 9(2):76–82

    PubMed  CAS  Google Scholar 

  44. Erol OO (2000) The Turkish Delight: a pliable graft for rhinoplasty. Plast Reconstr Surg 105(6):2229–2241

    Article  PubMed  CAS  Google Scholar 

  45. Daniel RK, Calvert JW (2004) Diced cartilage grafts in rhinoplasty surgery. Plast Reconstr Surg 113(7):2156–2171

    Article  PubMed  Google Scholar 

  46. Ertas NM, Hucumenoglu S, Bestalti O, Ozak A, Celebioğlu S (2000) The effects of oxidized, regenerated cellulose on diced cartilage xenograft: an experimental study. Ann Plast Surg 45(2):224–225

    Article  PubMed  CAS  Google Scholar 

  47. Daniel RK (2007) Rhinoplasty: septal saddle nose deformity and composite reconstruction. Plast Reconstr Surg 119(3):1029–1043

    Article  PubMed  CAS  Google Scholar 

  48. Daniel RK, Brenner KA (2006) Saddle nose deformity: a new classification and treatment. Facial Plast Surg Clin North Am 14(4):301–312

    Article  PubMed  Google Scholar 

  49. Emsen IM (2008) New and detailed classification of saddle nose deformities: step-by-step surgical approach using the current techniques for each group. Aesthetic Plast Surg 32(2):274–285

    Article  PubMed  Google Scholar 

  50. Gunter JP, Rohrich RJ, Adams WP (2002) Special emphasis on dorsal augmentation: autologous rib cartilage. In: Gunter JP, Rohrich RJ, Adams WP (eds) Dallas rhinoplasty. Quality Medical Publishing, St. Louis, pp 513–527

    Google Scholar 

  51. Thomassin JM, Paris J, Richard-Vitton T (2001) Management and aesthetic results of support grafts in saddle nose surgery. Aesthetic Plast Surg 25(5):332–337

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for Advanced Facial Plastic Surgery, Beverly Hills, CA, USA

    Babak Azizzadeh M.D., FACS

  2. The Center for Advanced Facial Plastic Surgery, 9401 Wilshire Blvd., Suite 650, Beverly Hills, CA, 90212, USA

    Babak Azizzadeh M.D., FACS

  3. Facial Plastic and Reconstructive Surgery, Boston Medical Center, Boston, MA, USA

    Waleed H. Ezzat M.D.

  4. Department of Otolaryngology/Head and Neck Surgery, Boston University School of Medicine, 820 Harrison Ave., 4FGH, Boston, MA, 02118, USA

    Waleed H. Ezzat M.D.

Authors
  1. Waleed H. Ezzat M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Babak Azizzadeh M.D., FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Waleed H. Ezzat M.D. .

Editor information

Editors and Affiliations

  1. Tustin, California, USA

    Melvin A. Shiffman

  2. Department of Plastic Surgery, Regional Hospital-Ancona, Ancona, Italy

    Alberto Di Giuseppe

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Ezzat, W.H., Azizzadeh, B. (2013). Costal Cartilage Grafting for Dorsal Augmentation. In: Shiffman, M., Di Giuseppe, A. (eds) Advanced Aesthetic Rhinoplasty. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-28053-5_34

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-28053-5_34

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-28052-8

  • Online ISBN: 978-3-642-28053-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation