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In our center at the National University Hospital of Singapore, the primary patient population seeking rhinoplasty consists of Asian patients seeking dorsal augmentation. The septal cartilage of Asian individuals is generally weaker and smaller, which makes it inadequate for use as a dorsal onlay graft, and Asian individuals are also more vulnerable to injury or secondary deformity.1 Autologous rib cartilage is the preferred graft material used at our center for its various advantages.2 The graft has excellent viability, achieves bony fusion to the nasal bones, and allows surgical molding. However, given the cartilage’s propensity for warping, precise crafting of the costal cartilage graft is of utmost importance.3 There have been many attempts to avoid potential warping, such as concentric carving, setting it aside in saline, and using internal Kirschner wire fixation.4 , 5 However, these methods are time consuming and tedious.
We describe a simple and efficient intraoperative method to enhance the symmetry of autologous rib graft implants for nasal augmentation. Intraoperatively, after the rib cartilage is harvested, it is crafted according to the desired measurements. This is shown in Figure 1, where the height of the graft is being measured. Parallel lines with the desired graft width are drawn on the cutting surface to visually guide symmetry during crafting. As shown in Figure 2 (a graft in the process of being crafted), asymmetry is easily visible with the aid of the parallel lines.
This simple visual guide allows the eyes to focus easily on perfecting symmetry during crafting of the dorsal onlay graft. This method does not require elaborate measurement materials, is cost-effective, and can be performed intraoperatively, where the size and cut of the graft can be adjusted immediately. The integration of efficient and economical methods of graft measurement—particularly costal cartilage for nasal augmentation—can aid in the final aesthetic outcome of augmentation rhinoplasty. In summary, we describe a simple technique involving the use of guide markers to facilitate the on-table judgment of graft symmetry and its precise crafting, a crucial part of rhinoplasty.
DISCLOSURE
The authors have no financial interest to declare in relation to the content of this article. There are no sources of financial support for this article.
Esther Wan Xian Tan, M.Phil.(Cam.), M.R.C.S.(Ed.)
Lee Han Jing, M.R.C.S.(Ed.), M.Med.(Surg.), F.A.M.S.(Plast. Surg.)
National University Hospital Singapore
Singapore
REFERENCES
1. Toriumi DM, DeRosa J. Rohrich RJ, Adams WP Jr, Ahmad J, Gunter JP. The Asian nose. In: Dallas Rhinoplasty: Nasal Surgery by the Masters. 2014:Boca Raton, Fla: CRC Press; 1226–1229.
2. Porter JP. Grafts in rhinoplasty, alloplastic vs autogenous. Arch Otolaryngol Head Neck Surg. 2000;126:558–561.
3. Park JH, Jin HR. Use of autologous costal cartilage in Asian rhinoplasty. Plast Reconstr Surg. 2012;130:1338–1348.
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