Costal Cartilage Graft in Rhinoplasty: fundamental aspects

Abstract

Costal cartilage is a reliable and abundant source for grafts in secondary rhinoplasty, parti- cularly in cases with insufficient septal cartilage. Its use is supported by its ability to provide structural support and meet both functional and aesthetic demands. However, its primary challenge lies in its tendency to deform, or “warping,” a phenomenon attributed to imba- lanced internal stresses within the cartilage. This article reviews the surgical techniques for costal cartilage harvesting, emphasizing the importance of a thorough anatomical unders- tanding to prevent complications such as pleural or neurovascular injuries. Various carving methods are analyzed, including concentric carving, the oblique split method, and more recent techniques such as the use of the costochondral synchondrosis. These strategies aim to minimize deformation and improve graft stability. Additionally, irradiated homologous rib cartilage (IHRG) grafts are discussed as an alternative in specific cases, highlighting their benefits and limitations, primarily related to long-term resorption. The article concludes that selecting costal cartilage as a graft material is essential in secondary and reconstructive rhinoplasty. Its successful use requires precise surgical technique and appropriate graft se- lection and preparation to maximize functional and aesthetic outcomes, minimize compli- cations, and ensure patient satisfaction.