Effects of Cutting Planes on Costal Cartilage Warping

Background Autogenous costal cartilage has become a favorable choice for nasal reconstruction and complicated aesthetic rhinoplasty because of its ample supply, sufficient for most patients. However, a notable drawback is the potential for warping. The authors’ study aims to identify cutting planes that minimize warping. Methods A total of 207 costal cartilage grafts were obtained by slicing the extracted costal cartilages from 10 fresh cadavers along 3 main planes: cephalocaudal, anteroposterior, and parallel to the synchondrosis plane. Each of these major planes was further divided into grafts taken from both the central and the peripheral portions. Furthermore, both subgroups were categorized into three thicknesses: 1, 2, and 3 mm. The warping angles of all grafts were then compared at various time intervals after the initial cutting. Results Cephalocaudal cuts exhibited significantly greater warping than other planes. Anteroposterior cuts displayed the least warping, although this difference lacked statistical significance. Peak warping occurred at 30 minutes. Certain grafts continued to warp even at 1 month. Central grafts had less warping than peripheral ones, although the difference was not statistically significant. Conclusions Cephalocaudal cuts yielded the highest warping angle. Surgeons seeking thin (<3 mm) straight grafts should opt for anteroposterior or parallel to synchondrosis planes. Thicker grafts (>3 mm) can be cut in the cephalocaudal plane with an acceptable warping angle, close to parallel with the synchondrosis plane. For curved cartilage, thin cephalocaudal cutting is recommended. In addition, the authors suggest placing the cartilage in normal saline for at least 30 minutes, allowing for maximum warping to occur.