I have recently stumbled across a blog entry on rib cartilage written by Drs. Litner & Solieman In their short overview of cartilage grafts, they state that in the absence of sufficient septal cartilage their preference of graft material would be irradiated donor rib cartilage as opposed to one's own rib cartilage. My question is, why not use irradiated donor septal cartilage before harvesting donor rib cartilage, knowing its shortcomings?
Rib Cartilage in Rhinoplasty Surgery?
Doctor Answers 4
Using rib cartilage in rhinoplasty
It really depends on the needs of the patient and the purpose of the cartilage. In general, autologous cartilage (cartilage harvested from your own body) is the best grafting material to restore the framework of your nose. Septal cartilage is my first choice. But in many cases, there may not be enough available, or the cartilage from the septum may be compromised. Using a PDS plate with ear cartilage is now a good choice, and can be a second option after septal cartilage. Rib cartilage is also a great choice. It is very strong, and much more rigid than ear cartilage, for example. In addition, a far greater amount can be harvested. Removing a portion of the cartilage from the rib does not affect support or structure to the rib cage. If perichondrium is left intact, cartilage can actually regrow in this area. Rib cartilage is also very versatile, and there are many reasons why this is beneficial during surgery. The versatility allows me to choose whatever type of cartilage I need for reconstruction. If it is curved, I’ll use it for the nasal tip. A piece of the middle aspect of the rib cartilage, which I know will be straight, is great for the middle vault of the nose. The straight portion also is good for filling in the nasal dorsum if we are going to use the chopped cartilage, versus the columellar strut for the spreader grafts. That being said, I would say it really depends on what you are using the cartilage for. With my cases, I assess the situation and determine what type of cartilage will allow me to accomplish what I set out to do during surgery and leave the patient with the best possible result. Thanks and I hope this helps!
Use of irradiated rib versus other cartilage in rhinoplasty
There is a variation among surgeons about their preferred cartilage graft source. Ear cartilage is not always strong (or straight) enough to use for certain rhinoplasty maneuvers.
Many surgeons have very good long term results with irradiated donor rib cartilage whereas other surgeon prefer using a patient's own rib if possible. Another factor is that ribn cartilage calcifies with time such that the rib cartilage in those who are older (e.g., 60 or 70 year old) may be too calcified to use during surgery.
Rhinoplasty - Cartilage Harvest
In the absence of sufficient septal cartilage, I generally will go to harvest ear cartilage. In the case of revision rhinoplasty, I may need to harvest the patient's rib cartilage. I prefer to use cartilage from within the patient's own body. Please consult with a board certified specialist who can best assist you in achieving the results you seek.
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Rib Cartilage in Rhinoplasty Surgery
In the absence of septal cartilage I prefer to use ear cartilage in most cases. There are problems with the survival of irradiated cartilage and therefore I feel the patient's own rib cartilage is better despite the fact that the patient will have discomfort after the harvesting of that cartilage.