Augmentation Rhinoplasty Workup

Author: Eugene A Chu, MD; Chief Editor: Arlen D Meyers, MD, MBA more...

Updated: Mar 13, 2012

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Imaging Studies

Imaging studies are generally not necessary. However, some authors have recommended limited preoperative computed tomographic scans of the sternum and ribs in elderly patients undergoing costal cartilage harvest. Experienced radiologists can determine the extent of calcification in the cartilaginous rib. Significant ossification may warrant the selection of alternative grafting material.

Proceed to Treatment & Management

Contributor Information and Disclosures

Author

Eugene A Chu, MD Clinical Instructor, Division of Rhinology, Johns Hopkins Department of Otolaryngology-Head and Neck Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Patrick Byrne, MD Associate Professor, Department of Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine

Patrick Byrne, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, and American College of Surgeons

Disclosure: Nothing to disclose.

Peter Hilger, MD Professor, Department of Otolaryngology, University of Minnesota Medical School

Peter Hilger, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, and Minnesota Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard V Smith, MD Director of Clinical Affairs, Associate Professor, Department of Otolaryngology, Division of Head and Neck Surgery, Einstein College of Medicine, Montefiore Medical Center

Richard V Smith, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, American Laryngological Rhinological and Otological Society, American Medical Association, American Medical Student Association/Foundation, Medical Society of the District of Columbia, New York Academy of Medicine, and Vermont State Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Dean Toriumi, MD Associate Professor, Department of Otolaryngology, University of Illinois Medical Center

Disclosure: Nothing to disclose.

Christopher L Slack, MD Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Medvoy Ownership interest Management position; Cerescan Imaging Consulting; Headwatersmb Consulting fee Consulting; Venturequest Royalty Consulting

References

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Bateman N, Jones NS. Retrospective review of augmentation rhinoplasties using autologous cartilage grafts. J Laryngol Otol. Jul 2000;114(7):514-8. [Medline].
Demirkan F, Arslan E, Unal S, Aksoy A. Irradiated homologous costal cartilage: versatile grafting material for rhinoplasty. Aesthetic Plast Surg. May-Jun 2003;27(3):213-20. [Medline].
Gunter JP, Rohrich RJ. Augmentation rhinoplasty: dorsal onlay grafting using shaped autogenous septal cartilage. Plast Reconstr Surg. Jul 1990;86(1):39-45. [Medline].
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Tardy ME. Cartilage graft reconstruction of the nose. In: Rhinoplasty: The Art and the Science. Vol 2. WB Saunders Co: 1997:648-723.
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Young boy with bilateral cleft lip and palate who also has midface hypoplasia and requires nasal augmentation.

Young boy (same patient as in the image above) with bilateral cleft lip and palate who also had midface hypoplasia and required nasal augmentation, shown after dorsal nasal augmentation was accomplished using autologous rib grafts. It was fashioned slightly larger than needed to account for the patient's future facial growth.

Woman with a subtype of midline granulomatous disease that caused nasal collapse. Augmentation was required.

Woman (same patient as in image above) with a subtype of midline granulomatous disease that caused nasal collapse, shown after augmentation with both autologous rib and cartilage grafts. AlloDerm was also used for additional augmentation.

Table. Advantages and Disadvantages of Graft Materials

Table. Advantages and Disadvantages of Graft Materials

	Advantages	Disadvantages
Septum	Easy harvest Present in the surgical field (no separate donor-site morbidity) Straight (good for certain purposes, such as a columellar strut)	May be deficient Straight (less desirable as batten graft)
Auricle	Easy harvest Relatively abundant Curved nature ideal for certain purposes	Separate donor site Curved (less desirable for some purposes)
Rib	Large volume (abundant, even for significant augmentation) Distant donor site (2-team approach possible) Reliable	Donor-site morbidity Warping possible

View Table List

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