Rib Cartilage Reconstruction after Nasal Bone Collapse from Over-Osteotomy – A Functional & Structural Revision Case

noselab
7월 18일
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최종 수정일: 7월 18일

Hello, this is Dr. Cha-Young Kang, Director of NoseLab Clinic.

Today, I’d like to share a highly complex revision case involving nasal bone collapse, breathing difficulties, and chronic pain due to an overly aggressive osteotomy performed in a previous rhinoplasty. We achieved both functional recovery and structural restoration using autologous rib cartilage reconstruction.

Case Background – Collapse after Over-Osteotomy

Preoperative consultation photos showing frontal, left oblique, and left side views of a patient with nasal bone collapse and mid-vault stenosis. — Preoperative design consultation photos: Frontal view, left oblique side view, and left side view.

Surgical History

The patient underwent dorsal hump reduction and osteotomy two years ago, with an implant-free approach using ear and septal cartilage. However, the osteotomy on the left nasal bone was too aggressive, leading to mid-vault collapse and septal damage.

Preoperative consultation photos showing right side view, right oblique view, and nostril view of a patient with nasal bone collapse and functional breathing issues. — Preoperative design consultation photos: Right side view, right oblique side view, and nostril view.

Complications

Severe nasal obstruction
Tightness and pain from nasal tip to gums
Nerve-related pain (neuralgia) in the nasal bridge area
Structural instability and breathing difficulty
Internal nasal valve stenosis (left side)

Patient Symptoms & Clinical Findings

The patient also suffered from allergic rhinitis, atopic skin, and was on immunosuppressive medication. She was unable to tolerate nasal taping, making wound care more challenging.

A CT scan revealed a collapsed nasal roof, narrowed airway, and damage to the septum and internal valve.

CT scan showing nasal bone collapse due to excessive left lateral osteotomy; inward deviation of the bone is marked with a blue arrow. — The left lateral osteotomy was overdone, causing the nasal bone to collapse inward.

Surgical Plan – Rib Cartilage Reconstruction

Core Reconstruction

Gradual lifting and realignment of the collapsed left nasal bone
Elevation of the nasal vault roof
Full framework reconstruction using autologous rib cartilage

Endoscopic view showing left internal nasal valve stenosis; narrowed nasal airway passage causing obstruction and asymmetry. — Left internal nasal valve stenosis

Internal Nasal Valve & Septum

Rebuilt the collapsed medial valve using rib cartilage
Septal reconstruction to restore symmetry and airflow

Vault and Roof Stability

Rib grafts used to reinforce upper lateral cartilages
Realignment of the nasal roof to restore structure and function

Postoperative Considerations

No nasal taping due to atopic skin
Gentle wound management under immunosuppressive care

Surgical Outcome

Preoperative Video / Immediate Postoperative Video

Frontal comparison of the patient before surgery (left) and immediately after autologous rib cartilage reconstruction (right), showing correction of nasal collapse and symmetry improvement. — Before Surgery (Left) / Immediately After Surgery (Right)

Structural Restoration

Restored nasal roof and vault
Symmetrical nasal bones
Natural nasal profile

Lateral view comparison before (left) and immediately after surgery (right), showing restored nasal bone contour and improved nasal roof height following rib cartilage reconstruction. — Before Surgery (Left) / Immediately After Surgery (Right)

Functional Recovery

Breathing fully normalized
Pain on touch eliminated
Internal valve reopened

Oblique side view comparison before (left) and immediately after surgery (right), illustrating nasal vault reconstruction, septal support, and realignment using rib cartilage graft. — Before Surgery (Left) / Immediately After Surgery (Right)

Nostril view before (left) and immediately after surgery (right), showing correction of asymmetry and internal valve reopening using rib cartilage graft. — Before Surgery (Left) / Immediately After Surgery (Right)

Surgeon’s Commentary

Immediately after surgery: Frontal, side, and oblique side views showing rib cartilage graft reconstruction of collapsed nasal bone and improved nasal contour. — Immediately after surgery: Frontal view, side view, and oblique side view photos.

Immediately after surgery: Nostril view showing symmetry correction and internal structural reconstruction using rib cartilage. — Immediately after surgery: Nostril view photos.

This case required precise anatomical analysis and delicate reconstruction techniques. Using rib cartilage allowed us to restore structure without introducing synthetic materials, which was crucial for the patient’s compromised skin and immune system.

We achieved not only physical improvement but also functional relief from neuralgia and nasal obstruction.

Even complex cases of nasal collapse due to prior surgical error can be successfully resolved with personalized, structure-based planning.

Thank you for reading.— Dr. Cha-Young Kang, NoseLab Clinic