title: Reconstructive Rhinoplasty Using Multiplanar Carved Costal Cartilage.
abstract: OBJECTIVE
  Reconstructive rhinoplasty often requires the use of cartilage grafts. Full-thickness autologous costal cartilage grafts provide a large amount of cartilage in a single uncarved block and are often used for major reconstructions. Warping is frequently described as a complication of rib cartilage use in rhinoplasty.
  
  
  OBJECTIVE
  To describe an approach to cartilage carving whereby a single block of cartilage is carved in a multiplanar manner to mimic or redefine the anatomic relationships and resist warping.
  
  
  METHODS
  A retrospective review of reconstructive rhinoplasty cases using multiplanar costal cartilage grafting technique was performed. A consecutive sample of 11 patients with complex nasal deformity underwent reconstruction with an autologous costal cartilage block carved in 3 dimensions to address complex deformities at the University of New Mexico Hospital between January 2010 and December 2014. The follow-up period ranged from 3 to 36 months.
  
  
  METHODS
  Autologous rib cartilage harvest was performed to obtain a full-thickness segment of rib cartilage. The deficient or malformed nasal cartilage is defined and soft tissue prepared using an open rhinoplasty approach. Rib cartilage graft curvature is removed to create a uniform, symmetric, solid block of cartilage. A cartilage graft is carved in a multiplanar fashion to simulate normal nasal anatomy.
  
  
  METHODS
  Postoperative evaluation of nasal airway function, cartilage graft warping, and aesthetic outcomes were reported in the follow-up period. Nasal Obstructive Symptom Evaluation (NOSE) scores are documented in the majority of cases and were obtained at least 3 months postoperatively.
  
  
  RESULTS
  Overall, 11 patients with complex nasal deformity underwent reconstruction with an autologous costal cartilage block carved in 3 dimensions. The most common use was for reconstruction of the septum with the upper lateral cartilage. There were no major complications. No patients experienced graft warping in the follow-up period. Several patients required minor revision procedures. All patients reported improved nasal airway and improved aesthetic appearance of the nose.
  
  
  CONCLUSIONS
  Multiplanar costal cartilage grafting is a useful surgical technique for complex reconstructive rhinoplasty that yields optimal and predictable results.
  
  
  METHODS
  4.
authors.affiliation: Department of Facial Plastic Surgery, Virginia Mason Medical Center, Seattle, Washington2Division of Otolaryngology-Head and Neck Surgery, University of New Mexico, Albuquerque.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Nuara
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, University of New Mexico, Albuquerque.
authors.forename: Randall B
authors.initials: RB
authors.lastname: Loch
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, University of New Mexico, Albuquerque3Department of Otolaryngology, University of Texas Southwestern, Dallas.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Saxon
mesh_terms: D066186:Costal Cartilage / Q000601:surgery / Q000637:transplantation*; D005260:Female; D006801:Humans; D008297:Male; D009666:Nose / Q000002:abnormalities* / Q000601:surgery*; D009667:Nose Deformities, Acquired / Q000601:surgery*; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000379:methods*; D014182:Transplantation, Autologous