Ultrasonographic Evaluation of Calcification Patterns in Costal Cartilage Implications for Rib Graft Harvesting

Importance Complex augmentation rhinoplasty often requires the use of cartilaginous grafts, especially in revision surgery. When using costal cartilage, the possibility of inadequate cartilage material because of excessive calcification must always be kept in mind. Furthermore, cartilage may be harvested but found to be not ideal, causing unsatisfying results. Objective To report our experience with the use of preoperative ultrasonographic (US) examinations for quality analysis of costal cartilage. Design, Setting, and Participants In an academic research setting, US imaging of the anterior rib cage was performed before 83 revision rhinoplasties requiring costal cartilage grafting. Main Outcomes and Measures Cartilage volume, quality, sex-specific calcification patterns, and the location of hidden calcification islands within viable cartilage were recorded. Results Two different calcification patterns, 1 central and 1 peripheral, were identified. Conclusions and Relevance We found this cost-effective technique to be a valuable tool for easy preoperative cartilage assessment. Furthermore, US screening guides the surgeon to areas of harvestable cartilage and to cartilage that is best suited for rhinoplasty in terms of distribution patterns of calcification areas. Level of Evidence NA.