Effects of Cutting Planes on Costal Cartilage Warping

Background: Autogenous costal cartilage becomes a favorable choice for nasal reconstruction and complicated aesthetic rhinoplasty, due to its ample supply, sufficient for most patients. However, a notable drawback is the potential for warping. Our study aims to identify cutting planes that minimize warping. Materials and Methods: Two hundred and seven costal cartilage grafts were obtained by slicing the extracted costal cartilages from 10 fresh cadavers, along three 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 peripheral portions. Furthermore, both subgroups were categorized into three thicknesses: 1mm, 2mm, and 3mm. 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, though 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 cut is recommended. Additionally, we suggest placing the cartilage in normal saline for at least 30 minutes, allowing for maximum warping to occur.