Long term durability of rib grafts for revision rhinoplasty?

Question

How durable is an autogenous dorsal rib graft for an overresected nose, once healing is complete? If, for example, you get elbowed in the face playing basketball or get into an accident resulting in trauma to the nose, would there be an appreciable risk of of the rib graft resorbing, warping, or becoming mobile or displaced? Would using a rib graft combined with k-wire mitigate any such risks, or does k-wire introduce its own set of problems by being a foreign body in the nose?

Vivek Bansal, MD · Answer

Thank you for your question! I have used rib grafts for many years for revision rhinoplasties (such as over-resected dorsum) and after nasal trauma (such as saddle nose deformity).  The literature is divided on this but my experience is that it is reliable and long-lasting.  Warping or bending can occur over time but that is a risk with any cartilage graft.  With a tight placement pocket and enough time for adequate fibrosis (healing), the risk of displacement should be low. I hope this helps!

Philip S. Schoenfeld, MD, FACS · Answer

In revision rhinoplasty with significant issues such as, tip, nasal valve or dorsal collapse, rib graft is an excellent source of cartilage with which to reconstruct the nose.  All of the potential issues of warping and resorption can occur without any trauma to the nose after placement of the graft.  Mild to moderate injury to the nose following reconstruction with a rib graft should not disrupt the graft or alter the nose if enough time has passed since rib graft placement.  I do not use K-wire for rib grafts and have performed many revision rhinoplasty surgeries with many rib grafts and have not found the need for K-wire.  There are reports that K-wire can decrease warping but injury to K-wire could certainly cause more damage to the rib cartilage than the damage that would occur without the K-wire.

Jonathan Kulbersh, MD · Answer

In my opinion, rib cartilage is the most stable and safe grafting material during a revision rhinoplasty.  After healing it is stable but I would reframe for intense contact sports for 6 months after surgery.  In regards to the K-wire, it is method to anchor the rib cartilage.  It would be very stable.  I do not use a k-wire personally so I cannot fully explain the pros and cons of using this device. I hope this helps.

Steven Wallach, MD · Answer

A rib graft is a great tool for revision rhinoplasty.   They can warp or bend over time but that is a risk of cartilage in general.

Francis R. Palmer, III, MD (retired) · Answer

You will, no doubt, get different opinions on this topic.  I have performed Rhinoplasty and Revision Rhinoplasty for over 25 years and in my opinion rib grafts will dissolve unevenly over time.  This could be as short as several years or as long as 10 but it's quite likely to occur.  This is why I won't use rib grafts in Rhinoplasty.  Silastic dorsal grafts are the best for building up the nasal bridge in my humble opinion.

Long term durability of rib grafts for revision rhinoplasty?

Answers (5)

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