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. 2015:2015:849802.
doi: 10.1155/2015/849802. Epub 2015 Dec 10.

Nose and Midface Augmentation by Rib Cartilage Grafts: Methods and Outcome in 32 Cases

Adham Farouk  1 , Saad Ibrahiem  1
Affiliations

Nose and Midface Augmentation by Rib Cartilage Grafts: Methods and Outcome in 32 Cases

Adham Farouk et al. Plast Surg Int. 2015.

Abstract

Recession of the midface is a relatively common condition that can have a negative impact on facial and nasal aesthetic appearance, and it poses a challenge to plastic surgeons. In cases with generalized maxillary retrusion and/or malocclusion, bone advancement surgery is required, but in localized cases, mostly seen in cleft lip patients, the quest is for an ideal material and a proper technique that would be used to augment the receding area. Throughout a period of seven years, thirty-two patients with nose and midface retrusion were managed by a construct of rib cartilage grafts designed to compensate the deficiency at the maxillary, piriform, and premaxillary areas. Results were satisfactory for most patients in terms of improved fullness of malar area, improved nasal tip projection and rotation, and improvement of upper lip. The presented technique of rib cartilage grafting is a safe and effective method for nose and midface augmentation.

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Figures

Figure 1
Figure 1
(a) Computed tomography pictures of two patients; arrows point to maxillary and piriform deficiency. (b) Computed tomography picture used to fashion the design of the cartilaginous construct (superimposed blue shapes).
Figure 2
Figure 2
Carving rib cartilage grafts. (a) Carving a straight rod out of the central portion of rib cartilage specimen. (b) Carving thin plates out of the peripheral portion of rib cartilage specimen.
Figure 3
Figure 3
(a) Diagram illustrating the incision along the border of upper lip and nasal sill to expose the maxilla and piriform aperture, and the transcolumellar infracartilaginous incision to expose the nasal skeleton. (b) Diagram showing the planned shapes and arrangement of the cartilaginous implants.
Figure 4
Figure 4
Two views during implantation of the rib cartilage construct.
Figure 5
Figure 5
Example (1) for clinical results of rib cartilage grafts. (a) Preoperative views of a patient with recession of nasal floor, alar base, and malar area, and obtuse nasolabial angle. (b) Two-week postoperative views showing improved receding elements, nasal tip rotation, and upper lip thrust. (c) Superimposed blue shapes demonstrate the relative size and position of the cartilaginous implants.
Figure 6
Figure 6
Example (2) for clinical results of rib cartilage grafts. (a) Preoperative views of a patient with premaxillary and maxillary retrusion. (b) Three-year postoperative views showing augmented midface, nasal rotation, and upper lip thrust.
Figure 7
Figure 7
Example (3) for clinical results of rib cartilage grafts. (a) Preoperative views of a patient with premaxillary depression and droopy nasal tip. (b) Two-year postoperative views showing augmented midface, nasal rotation, and upper lip thrust.
Figure 8
Figure 8
Picture of a complication which occurred. (a) Skin necrosis at distal part of the columellar flap. (b) Exposure of a part of the rib cartilage graft.
See this image and copyright information in PMC

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