Osseocartilaginous rib graft rhinoplasty: A stable, predictable technique for major dorsal reconstruction

Objective: To assess the long-term stability of osseocartilaginous dorsal onlay rib grafts used for augmentation rhinoplasty. Methods: Patients who had rib grafts used for augmentation rhinoplasty from 2000 through 2009 were assessed for graft viability, graft mobility, graft warping, maintenance of dorsal projection, functional airway status, need for revision surgery, and donor site morbidity. A retrospective cohort study using telephone follow-up was conducted. Results: A total of 58 rib graft rhinoplasties were performed in the 10-year review period, 39 of which used dorsal onlay grafts. The mean duration of clinical follow- up was 24months, and the median duration of clinical follow-up was 16 months. Thirty-three of 33 sseocartilaginous onlay grafts (100%) and 5 of 6 cartilaginous onlay grafts (83%) were viable, rigid, and had maintained dorsal projection at last follow-up. None of the grafts warped. Twenty-nine of 33 patients receiving osseocartilaginous onlay grafts (88%) and 5 of 6 patients receiving cartilaginous onlay grafts (83%) had persisting relief of their nasal obstruction. Twelve of the 39 patients (30%) had revision surgery, mostly performed for minor cosmetic revision. Conclusions: Osseocartilaginous onlay rib grafts provide an ideal scaffold for dorsal nasal augmentation and restoration of nasal airway in patients with collapse of the nasal framework due to a saddle deformity, history of trauma, or history of multiple septorhinoplasties. The graft has excellent viability, lacks potential for longterm warping, achieves bony fusion to the nasal bones, and allows surgical molding of the cartilaginous tip.