Premature Calcifications of Costal Cartilages: A Different Problem For Revision Rhinoplasty Operations

Premature Costal Cartilage Calcifications May Leads to Inadequate Cartilage Tissue Obtaining, Increased Risk of Pneumothorax

Premature Costal Cartilage Calcifications - Revision Rhinoplasty Operations - Rib Cartilage Grafting

In revision rhinoplasty operations, there are 3 options to obtain cartilage tissue in the hands of coarse surgeons when there is no sufficient amount of cartilage tissue left for nose cartilage graft preparation and nose reshaping:

1. auricle cartilage of the patient's own ear. The auricle cartilage is angled and soft. In the reconstruction of the nasal support tissue, the rib is not as stiff and rigid as cartilage.

2. The patient's own rib cartilage. Costal cartilages are intact and thick, and they are defined as "oblique incision" techniques because they are angled and can be bent after the procedure. Pain after costal cartilage grafting, a rare risk of lung injury during the procedure, causing additional operation time, as well as increasing the age of "costal cartilage calcification" especially in patients aged 30 years, there is a risk of not getting enough cartilage grafts.

3. Irradiated cavaeric rib cartilage. Irradiated tissue of rib cartilage belonging to other human.

Premature Calcifications of Costal Cartilages

Calcification of rib cartilages may occur due to sex and genetic causes and is usually not radiographically apparent until the age of 30 years. The forms and onset of these costal cartilage calcifications were used to determine the sex and age of unknown bodies in the forensic medicine. However, the early calcifications of the lower rib cartilages I have written here can emphasize that sufficient cartilage tissue can be "usable esnasında during revision rhinoplasty operations, and the clinical significance of prematur costal cartilage calcifications, except for this particular condition, has not yet been fully elucidated. In the case reports, premature calcification of hyperthyroidism, corticosteroid drug and rare congenital diseases such as adrenogenital syndrome or Keutel syndrome are emphasized.

Perhaps, especially in patients aged 40 and over, radiological examinations can be used if "rib cartilage grafting" is planned before the revision nasal esthetic operation. In this case, it may be useful to avoid surprises during surgery.

Rib Cartilage

Autogenous cartilage is considered an ideal grafting material for revision nasal surgery. In this way, the risk of tissue reaction is minimized. Septal and contal cartilages of the patient are good sources of grafts for septorhinoplasty. However, in "complicated revision rhinoplasty operations" with severe deformations requiring extensive reconstruction, this cartilage may not be present in sufficient amounts. Rib cartilages can provide an abundant source of cartilage for graft formation and are the most reliable reconstruction material except nasal septum cartilage when structural support is required. During costal cartilage grafting, cartilage is usually collected from the sixth, seventh or eighth rib, most often due to the cartilage curvature. In addition, the surgeon may combine parts of the sixth synchondrosis with the eighth rib cartilages.

Premature Costal Cartilage Calcifications - Inadequate Cartilage Tissue Obtaining and Difficult Manipulation

Calcification leads to unexpected absorption and difficult manipulation, resulting in worsening of surgical results. Furthermore, during cartilage grafting, the risk of donor site morbidity, including pneumothorax, may be increased if rib cartilage is calcified. To date, only a few studies have provided information on the characteristics of rib cartilage calcification. However, most studies did not evaluate cartilage for rhinoplasty and were forensic studies in Western countries. Costal cartilage calcification can be investigated prior to nasal surgery using computed tomographic (CT) scans of the chest or abdominal radiographs.

Revision rhinoplasty is already a surgery like "opening the surprise box"

Revision nasal aesthetic surgery is a surgical procedure in which all the details can be understood already during the operation and it may be necessary to use different, unpredictable maneuvers and techniques during the operation. In order to avoid additional surprises, it should be emphasized that "premature calcification of rib cartilages" may be required prior to revision rhinoplasty operations for older patients and may require additional auricle cartilage or cadaveric rib cartilage during surgery.

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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