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20 Jun 2024 (Vol 47 , Iss 06 )

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31 May 2024 (Vol 47 , Iss 05 )

Journal ID : TMJ-05-11-2021-10780
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Title : Challenges in Harvesting Rib Cartilage in Reconstructive Rhinoplasty

Abstract :

Harvesting rib cartilage graft (RCG) in secondary rhinoplasty is considered as one of most common operations with good result and high percentage of patients' satisfaction despite the complications of the operation. To discuss the feasibility of RCG in reconstructive rhinoplasty in our society. This prospective study include 60 patients (36 Female 24 males with a male to female ratio of 6.5:8.5) aged between 18-48 years (mean age 31.45 years) were operated upon during the period between June 2016 and January 2020 at Zakho Private Hospitals, Dohuk, Iraq. Those patients underwent open septorhinoplasty by using harvested autologous RCG. The rhinoplasty was primary in one case (1.7%), tertiary in 7 cases (11.7 %) and secondary in the rest 52 cases (86.7 %). The patients were divided into three groups according to their nasal deformities Thirty-six patients (60%) having significant loss of dorsal volume and septal support. 24 patients (40%) having short contracted nose. Additional tip support was required in 40 patients (66.7%). The harvested RCGs were the 6th in 52 patients (86.6 %), the 7th in 6 patients (10%) the 8th rib in 1 patient (1.7 %) and both 6th and 7th in 1 patient (1.7 %) depending on the size, curvature and flexibility of the required cartilage. The study was performed on adult patients, The 6th RCG was harvested in 52 cases, while the 7th was harvested in 6 cases and the 8th in one case. Both 6th and 7th RCGs were harvested in one case. Complications at donation site were pneumothorax in 7 cases (12%), wound infection in 2 patients (3.3%) which were successfully treated with oral antibiotics, seroma in 1 patient (1.7%) and 1 patient (1.7%) suffer from persistent pain for three months. No one developed keloid scar of the chest incision. Complication reception site None of the 60 patients had grafts extrusion. Four patients had infection in recipient sites. Warping defect was noticed in 3 patients. Four cases required revision surgery. The mean postoperative follow-up duration was 12 months. Autologous RCG is indispensable in reconstructive rhinoplasty when large quantity of grafting materials is required to substitute the severe loss of nasal support. Every effort is recommended to avoid complications and morbidities and to get acceptable results and best patient’s satisfaction. Surgeons must pay attention to pneumothorax and choose the surgical techniques to reduce postoperative pain and to avoid warping and operative look.

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