Major Risks of Revision Rhinoplasty Using Rib Cartilage?
- Asked by maryam in Iran
- 4 years ago
Use of rib cartilage in revision rhinoplasty
There are three types of cartilage used in revision rhinoplasty. The first choice is always cartilage from the septum, as it is straight, firm cartilage which does not require harvesting from outside of the nose. In cases where septal cartilage has already been used during previous surgery, the next choices are ear and rib.
Ear cartilage can be excellent for certain smaller grafts but tends to be weaker than septal cartilage and may not be strong enough for reconstructing noses which require major support.
Rib cartilage can also safely and effectively be used in revision rhinoplasty. The cartilage can be autologous, which means that it comes from the patient, or irradiated, which is donated by an individual who is deceased. The harvest of rib cartilage is done through an inconspicuous 2-3 cm incision, which can be tucked under the right breast in women. The first risk related to harvesting this cartilage is injury to the underlying lung or tissue layer around the lung, called the pleura. This can result in air being introduced around the lung, what is known as a pneumothorax. This extremely uncommon complication can be managed by temporary placement of a chest tube for a few days following the procedure. Other risks related to rib cartilage include the grafts becoming visible under the skin, shifting of the grafts, and resorption, or dissolving of the grafts. This risk of resorption is thought to be greater when the cartilage is irradiated (cadaveric cartilage). In general, use of rib cartilage is extremely safe and for surgeons who specialize in revision rhinoplasty, the benefits of utilizing rib cartilage greatly outweigh these risks.
Rib grafts are a good option
If the nose needs structure, then the first place the surgeon looks is inside. However this usually isn't an option because the loss of cartilage/bone is the reason the surgeon is looking for material. Therefore we go farther a field. First the ear or both ears, then the rib. We used to use the skull and before that, the pelvis.
The problems with rib are the extra site of surgery, possible local complications (although these are rare), and the quality of the cartilage is different than the nose and not as good unfortunately.
Rib cartilage is most often used in nasal surgery when a larger amount of cartilage is needed. In experienced hands the potential complications are minimized. If I personally needed a rib graft for my revision rhinoplasty, I would have the procedure without hesitation. For a list of specific possible complications, ask during your consultations.
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Rib cartilage for rhinoplasty
Rib cartilage is often used in rhinoplasty for patients that need augmentation of their nasal bridge. Harvesting the rib is fairly straightforward. It will leave a permanent scar on the chest that is usually no more than a few inches long. The biggest complication from the harvest is a potential for a pneumothorax ( collapsed lung).
Rib Cartilage Grafting for Revision Rhinoplasty
In revision rhinoplasty, it is usually necessary to reconstruct and reshape the nasal framework using cartilage grafts. Because available septal cartilage has usually been removed during the first surgery, grafts must obtained from either another site - the ear or the rib.
Rib cartilage has many uses and advantages in revision rhinoplasty. It can be carved or shaped to the desired configuration. Its rigidity can provide support to a weakend nasal framewoek.
Drawbacks of Rib Cartilage Include:
- Rendency to warp (curve). This can make the result unpredictable.
- Nose may feel firm or inflexible.
Potential Risks of Rib Cartilage Harvest:
- Collapsed lung (pneumothorax)
- Chest wall deformity
However, in experienced hands, rib cartilage allows successful results in revision rhinoplasty.
Web reference: http://rhinoplasty-usa.com/html/meet-dr-cochran.html
Risks of revision rhinoplasty using rib (costal) cartilage
The risks are generally low when performed by an experienced surgeon but they can include (and are not limited to):
infection, bleeding, hematoma, wound breakdown, hyperftrophic or keloid scar formation, contour irregularity, hemo/pneumothorax, graft resorption or warping, overcorrection, undercorrection, graft rotation/extrusion/exposure, inability to acheive a specific funtional and/or cosmetic result.
Revisions Rhinoplasty with Rib cartilage
Revision rhinoplasty presents many challenges, including where to find cartilage to rebuild important structures. Most surgeons use septal cartilage as a primary material. If not available ear cartilage is the next choice.
When a large amount of cartilage is needed, and the septum and/or ear are not sufficient, rib is the next logical material. Even then we have the choice of using a patients own rib, or obtaining cadaver rib instead. Both can be effective. Great care must be taken to carve the rib grafts, and to minimize the warping which can occur. When needed, this can be an excellent material.
Rib cartilage is commonly used for revision rhinoplasty
Rib cartilage is a common source for revision rhinoplasty. My first choice would be septal cartilage (from inside the nose). If there is not enough cartilage, I like to use ear cartilage using an incision behind the ear. Sometimes, this is not enough cartilage, and rib can be used with a high level of safety, in the right hands. As with any surgery, there are some risks which your surgeon can discuss with you.
Major risk of rib cartilage is warping
Rib cartilage is notorious for warping. It tends to have a memory and tends to warp after time. I alos find rib cartilage to be a bit too stiff which undoubtedly leads to a nose that is a bit too stiff.
Long term results with rhinoplasty and rib grafts
The risks of rib cartilage harvest and grafting really relate to graft uptake. The expertise of the surgeon will determine whether there is graft uptake and survival, thus maintaining longterm surgical results.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.