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. 2018 Feb;26(1):55-60.
doi: 10.1177/2292550317740690. Epub 2017 Nov 21.

How to Prevent Costal Cartilage Graft Warping in Secondary Correction of Cleft Lip Nasal Deformity

Hung-Chang Chen  1 , Cheng-I Yen  1 , Shih-Yi Yang  1 , Yen-Chang Hsiao  1
Affiliations

How to Prevent Costal Cartilage Graft Warping in Secondary Correction of Cleft Lip Nasal Deformity

Hung-Chang Chen et al. Plast Surg (Oakv). 2018 Feb.

Abstract
in English, French

Introduction: Autologous costal cartilage dorsal onlay graft is widely used for dorsum and radix augmentation in secondary cleft lip nasal rhinoplasty. The most common drawback of costal cartilage dorsal onlay graft is warping. The purpose of this article is to describe our chimeric autologous costal cartilage graft technique, which prevents warping significantly. "Chimeric" means the combination of 2 different tissues (bone and cartilage) to make a single dorsal onlay graft.

Patients and methods: From June 2011 to June 2014, 16 cleft lip patients who underwent rhinoplasty and needed dorsal onlay grafts with costal cartilage graft using the chimeric autologous costal graft method were identified. All patients were operated by the corresponding author. Patients' nasal profiles were documented and photographed preoperatively and postoperatively.

Result: There were 5 males and 11 females with ages ranging from 20 to 52 years (averaging 29.5 years). There were 14 unilateral and 2 bilateral cleft lips. The average follow-up time was 12.1 months. Six patients received revision surgery, including 1 (6%) warping and 5 (30%) revisions. All patients were harvested rib cartilage graft as cartilage donor and there was no complication with the donor site.

Conclusion: From the clinical observation of all patients during the follow-up period, this technique is effective for preventing cartilage warping.

Historique: L’autogreffe dorsale d’apposition du cartilage costal est largement utilisée pour l’augmentation du dos et de la racine du nez lors de la rhinoplastie secondaire de la fente de la lèvre et de la cavité nasale. La déviation est le principal inconvénient de ce type de greffe. Le présent article vise à décrire la technique d’autogreffe chimérique de cartilage costal, qui évite la déviation de manière significative. « Chimérique » signifie la combinaison de deux tissus (os et cartilage) pour former une seule greffe dorsale d’apposition.

Patients et méthodologie: Entre juin 2011 et juin 2014, 16 patients ayant une fente labiale ont subi une rhinoplastie accompagnée de greffes dorsales d’apposition de cartilage costal à l’aide de la technique d’autogreffe costale chimérique. Tous les patients ont été opérés par l’auteur-ressource. Le profil nasal des patients a été consigné au dossier et photographié avant et après l’opération.

Résultat: Cinq hommes et 11 femmes de 20 à 52 ans (moyenne de 29,5 ans) ont subi l’opération, pour un total de 14 fentes labiales unilatérales et deux fentes labiales bilatérales. Ils ont participé à un suivi moyen de 12,1 mois. Six patients ont subi une opération de révision, y compris une déviation (6 %) et cinq révisions (30 %). Le cartilage costal avait été prélevé dans les côtes chez tous les patients, qui étaient leurs propres donneurs. Il n’y a eu aucune complication au site de prélèvement.

Conclusion: D’après l’observation clinique de tous les patients lors du suivi, cette technique prévient la déviation du cartilage.

Keywords: cleft lip nasal deformity; costal cartilage graft; warping.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Coronal view, 1 to 5 steps of chimeric autologous costal cartilage graft.
Figure 2.
Figure 2.
Intraoperative view of case 1.
Figure 3.
Figure 3.
(Above) Preoperative 45°, frontal, and lateral views of case 1. (Below) Postoperative 45°, frontal, and lateral view after 10 months.
Figure 4.
Figure 4.
(Above) Preoperative lateral, frontal, and 45° views of case 2. (Below) Postoperative lateral, frontal, and 45° views after 1 year.
Figure 5.
Figure 5.
Intraoperative view of case 2.
Figure 6.
Figure 6.
(Above) Preoperative frontal and lateral views of case 3. (Below) Postoperative frontal and lateral view after 2 months.
Figure 7.
Figure 7.
Intraoperative view of case 3.
Figure 8.
Figure 8.
(Above) Frontal and lateral views of case 2, 24 months after surgery. Warping was noted at the upper part of dorsal graft. (Below) Frontal and lateral view 1 month after revision.
See this image and copyright information in PMC

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