The Use of Rib Cartilage in Nose Surgery – near Manchester, New Hampshire
When performing nose surgery, Dr. Mark Constantian finds that it is nearly always necessary to use a nasal graft to maintain stability and create a balanced, natural appearance. Because artificial materials are impermanent and unreliable, Dr. Constantian prefers to use only the patient’s own cartilage or bone to produce grafts. Rib cartilage is often used in nose surgery at our practice, near Manchester, New Hampshire, as a grafting material. This page addresses many of the common questions patients have about the use of cartilage from the ribs.
- “I have heard that rib cartilage is hard to use or isn’t good. Is that true?”
Of all the possible donor sites for cartilage grafts, rib is the most quirky; but it also is unsurpassed for certain types of reconstructions. When a patient has already had septal cartilage removed but needs a straight, single-unit nasal graft to recreate the bridge, rib is a wonderful material, and it has become my graft of choice in many complex nose surgery applications.
Like septal and ear cartilage, rib cartilage has tremendous internal stresses, only to a greater degree. Normal inhalation is caused by the contraction of the muscles between the ribs, but exhalation is entirely caused by elastic recoil of the expanded ribs. Nature has endowed human ribs with such perfectly balanced internal forces that the rib cage returns to exactly the same size minute after minute, all through a person’s life. However, reducing a section of rib that is originally the size of your little finger to a narrow strip that will recreate the bridge disturbs those forces, and surgeons who want to use rib successfully need to learn what will work in a particular patient and what will not.
- “How often do you use rib cartilage and how successful is it?”
Because of the patients I see, I use rib cartilage commonly for nose surgery procedures at my New Hampshire practice outside Manchester. I recently reviewed my experience with a series of 125 consecutive patients in whom I had used rib cartilage for the nose and looked at what factors influenced the final result. Was it the type of graft I made, the age of the patient, or the experience of the surgeon? In fact, none of those factors was a big influence on the outcome. What determined outcome the most was the quality of the donor rib. The better the building material, the better the chance for a very good or excellent result.
Rib characteristics vary with age. In general, younger patients have whiter, more elastic rib cartilage that is softer and more malleable but more likely to curl. Older patients have yellower, stiffer rib that is more calcified and less likely to deform but also more difficult to slice thinly or crush. Just like becoming adept at any type of surgical procedure, the only way to learn to use rib cartilage in nose surgery with a good chance of success is through experience. The wonderful thing about using the patient’s own tissues is that, once things are healed, if the result looks good, it will be good forever. The same cannot be said of any type of artificial implant, which may look good initially, but which can cause problems over the long term. That is why, despite the difficulties, I always use the patient’s own tissues: I want to create permanent results for the patient.
- “How will the use of rib cartilage affect my operation and recovery?”
The rib cartilage can be removed through a one-inch incision in the lower chest. There is some discomfort for 48 – 72 hours, but patients are still able to leave the hospital the same day.
Contact Our Practice
To learn more about how rib cartilage can be used in nose surgery, contact our New Hampshire practice, located south of Manchester, near the Massachusetts border.