With no septum available, a rib graft is the best alternative

The woman I wrote about last time had a very good outcome. I opened her scarred airways and placed “composite” grafts of cartilage and skin from one of her ears into the gaps to replace the lining that previous surgeons had removed, so now she has normally-sized airways. We will have to splint these open at night for a few months so we don’t lose some of the correction, but she can now breathe though her nose for the first time in 2o years. At the same surgery, I rebuilt the external nose with rib grafts so that her appearance is much more normal.

Rib grafts have an undeserved bad reputation. When septum is not available, rib is the patient’s best chance for a life time solution. Nevertheless, rib can warp if it is not handled skilfully—and even the most experienced surgeons have to revise some results. As we age, our ribs become stiffer and more calcified, so they distort less as they heal. This woman was 60, so her rib should be excellent and her result dependable.

Even the most difficult problems can be solved by following good surgical principles—using the patient’s own tissues, limiting dissection, ad recreating the normal.