Sagittal Oblique Splitting of Rib Cartilage for Overcoming of Warping
One of the significant challenges in utilizing rib cartilage for rhinoplasty is the susceptibility to warping. Traditional rib slicing techniques can result in warping due to the mechanical stresses exerted on the cartilage. Various methods have been proposed to mitigate this issue. In this study, we aim to demonstrate the advantages and disadvantages of our approach: Sagittal Oblique Splitting (SOS). This technique, due to its specific cutting angle, minimizes the propensity for rib cartilage to warp and twist.
Methods/Technique
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In this technique, cartilage is harvested from the 6th or 7th rib. The most medial point on the anterior surface of the rib is marked, after which the longest diagonal line that can be drawn without curvature on the rib is delineated. Using a dermatome blade, the rib is sliced into sections approximately 2 millimeters thick. Typically, three to four pieces of cartilage are harvested from the midsection in this manner. The harvested cartilage is subsequently immersed in normal saline for approximately 20 to 30 minutes.
Cartilage segments were utilized as spreaders or struts in patients requiring structural support. One year postoperatively, the patients were evaluated for the presence or absence of warping. Additionally, a piece of unused cartilage was preserved in normal saline for one month, during which potential rotation of the cartilage was assessed at intervals of one day, one week, and one month. The degree of warping in these samples was compared to their original state prior to incorporation into the nasal framework.
Results/Complications: *
After one year, patients exhibited either no warping or only minimal warping that did not elicit any complaints. Furthermore, no warping was observed in the in-vitro samples.
Conclusion
:The sagittal oblique slicing technique appears to be an effective method for addressing rib cartilage rotation. The angled cuts achieved through this technique facilitate control and redistribution of the forces responsible for cartilage warping, leading to an even distribution of stress across both sides of the cartilage segment and effectively preventing the warping process.