Enhancing Dorsal Contour: Autogenous Rib Cartilage Augmentation Explained
Enhancing the dorsal contour mainly involves facial aesthetics, with nasal dorsal reduction reshaping to the bridge of the nose to achieve a balanced and harmonious appearance. Various techniques are available to improve the dorsal contour with autogenous rib cartilage, a popular choice for its versatility and natural-looking results.
Define Autogenous Rib Cartilage
Reconstruction of the nasal osteocartilaginous framework is the foundation of successful primary and secondary rhinoplasty.
Autogenous rib cartilage is a graft material for dorsal augmentation when adequate septal cartilage is unavailable. When ample septal cartilage is unavailable, the rib provides a plethora of cartilage for graft fabrication. It is trustworthy when structural support is needed.
Define Dorsal Augmentation
Dorsal augmentation is also known as dorsal hump reduction or dorsal nasal augmentation. It is a cosmetic surgical procedure aimed at enhancing the appearance of the nasal dorsum.
In this procedure, the surgeon uses various techniques to modify the contour and profile of the nasal dorsum, which varies according to the patient’s desired goals. Also, volume or height should be added to the nasal bridge to create a more balanced and harmonious facial profile. Equally, it can also reduce a prominent dorsal hump to accomplish a smoother, straighter nasal contour.
Individuals need to consult a best nose surgeon in India, Dr. Debraj Shome, to discuss their goals and explore the most suitable treatment based on their unique anatomy.
How does dorsal augmentation help with Autogenous rib cartilage?
Dorsal augmentation denotes adding volume or height to the dorsum or the bridge of the nose during rhinoplasty surgery. Autogenous rib cartilage can be used to build the nasal bridge in dorsal augmentation. Here’s how it helps are as follows:
- Customization: Autogenous rib cartilage enables precise customization, including shape and contour customization. Surgeons can shape the cartilage graft to match the patient’s requirements.
- Increased Dorsal height: Autogenous rib cartilage can be sculpted to create the desired height and contour along with the nasal dorsum. This can be used for patients who have depressed or flat nasal bridges.
- Long-term results: Autogenous rib cartilage amalgamates well with surrounding tissues and provides long-term results. It can preserve its shape and stability, resulting in enduring nasal contours.
Overall, dorsal augmentation with autogenous rib cartilage can enhance the appearance of the nasal bridge in rhinoplasty with a safe and reliable solution. Top of Form
Explain the method of the Rib Harvest Technique.
The rib harvest technique is a surgical extraction of cartilage from the patient’s ribcage to use in miscellaneous reconstructive procedures such as rhinoplasty, ear reconstruction, or facial augmentation. Here’s the method as follows:
Patient Assessment: Before proceeding with rib harvest, the surgeon evaluates the patient’s medical history and surgical goals. It assists in determining the suitability of rib cartilage as a graft material and the optimal harvesting site.
Anesthesia: The patient is placed under general anesthesia to ensure comfort during surgical procedures.
Incision: The surgeon makes a small incision around 3-5cm long. Usually, the incision is made at the lower margin of the ribcage to minimize scarring and reduce postoperative discomfort.
Dissection: After the incision, the surgeon dissects through the layers of tissue to access the ribcage. Safety measures have been taken to protect the surrounding structures, such as nerves and blood vessels.
Rib Harvest: Once the ribcage is visible, the surgeon identifies the appropriate ribs for harvest based on the desired amount of cartilage needed for the patient’s anatomy.
Cartilage Extraction: Using precision surgical instruments, the surgeon removes a segment of rib cartilage.
Closure: After the operative procedure, the surgeon closes the incision and dresses the wound with sterile bandages to promote healing and avoid the risk of infection.
Postoperative Care: The patient is closely monitored to ensure proper healing. Pain medications and antibiotics are prescribed to help quick recovery and prevent infection.
Recovery: The recovery period varies from patient to patient and depends on the extent of the procedure. In the initial phase, patients need to avoid tough activities and exercise to allow the ribcage to heal properly.
Overall, rib harvest provides a reliable source of autogenous cartilage for various reconstructive procedures & offers natural and long-lasting results.
Recipient Site Preparation
Before graft preparation, the structure of the nose must be prepared to receive the dorsal graft. The recipient bed must be as flat and smooth as possible to give the most significant surface area for the dorsal onlay graft to contact. The dorsal septum and upper cartilages are trimmed with no 15-blade, and any contour irregularities of the bony dorsum are removed with a drill. A uniform surface of the dorsal recipient bed helps adhere to the osseocartilaginous framework. It helps prevent postoperative movement of the graft after healing is complete, which is often seen in grafts placed in soft tissue envelopes. Irregular soft tissues and scar tissue should be carefully removed from the undersurface of the soft tissue that envelope to prevent overlying irregularities.
In the second rhinoplasty, the dorsum was over-resected, and the septal “L-strut” was weakened. In this case, dorsal spreader grafts should be placed along the side of the septum to provide a stable platform for the dorsal onlay graft. The spreader grafts should be secured with horizontal mattress sutures at the same level as the septum and extend from the keystone areas to the septal angle.
Spreader grafts are also used to widen a narrow dorsum. They are used in preparation for receiving the dorsal onlay graft. If the nasal bones are too narrow, medial osteotomies are performed, and the spreader grafts extend the cephalad.
To prepare for the placement of the columellar strut sizer, a pocket is separated between the medial crura to exhibit the nasal spine, which is removed with a rongeur. A drill with a 1.0 mm wire passer bit is used to place a 10.0mm drill hole lateral to the maxillary midline. It prevents the damage to the incisive foramen. The hole is drilled to a depth of 11 to 12 mm and lays parallel to 2 to 3 mm inferior to the nasal floor. After drilling this hole, a smooth 0.028-inch K wire is placed in the drill hole to make sure that it is contained in the bone of the palate and does not perforate intraorally. If it did, a new drill hole is placed on the opposite side of the midline of the maxilla.
Graft Preparation
Before reshaping, the grafts are begun, and the silicone sizers are used to estimate the shape and size of the needed grafts. The surgeon refabricates the silicone sizers. Molds of anatomically shaped dorsal onlay grafts and columellar struts are carved in a paraffin wax block in an assortment of shapes and sizes. Room-temperature vulcanizing silicone is mixed and poured into the mold and left for 24 hours to polymerize before trimming to the final forms.
In the maxillary drill hole, the columellar strut graft and the dorsal onlay graft are placed after the preparation, and the appropriate length sizer is selected. With the columellar sizer in place, miscellaneous dorsal sizers are placed on the dorsum, and the skin is redraped until the desired combination is determined.
