Slechte indicaties voor homoloog ribkraakbeen gebruik tijdens rhinoplastiek

Researchers: Floris van Zijl, Frank Datema

The use of homologeous rib cartilage in rhinoplasty is well described in literature and given most indications known as safe, effective and durable material.

Routine outcome measurements in rhinoplasty, prospectively applied to all our Erasmus MC patients since 2014, not only allows us to be transparent about our results, but automatically identifies extreme successes and failures. This allows us to critically appraise medical charts to learn from our ‘home run’ surgeries in order to optimize our techniques and indications, but more importantly to prevent repetitive mistakes.

Interestingly, our rhinoplasty failures showed a high correlation with the use of homologous, irradiated and chemically treated, rib cartilage. This motivated us to perform a retrospective study of all our patients in which this material was used since april 2014.

We conclude that three specific patient categories should not be treated, using this material: 1. GPA patients (even those in full remission); 2. ex cocain users with a subtotal septal perforation; 3. thick skinned patients, requiring extensive repair of tip supportive structures. In all other patients the use of this specific graft material is considered safe and effective, as long as the grafts are not placed under tension. Slight overcorrection to anticipate moderate resorption and subsequent volume loss in case of augmentation grafts seems advisable.