Evaluation of Costal Cartilage Calcification Using Plain Radiographic Images

Costal cartilage is a vital autologous graft for structural rhinoplasty, but calcification complicates surgical planning and graft manipulation. Chest computed tomography is the conventional evaluation method but is not routinely used owing to radiation exposure and cost.

To evaluate, using plain rib series radiography, the prevalence, morphological patterns, and predictors of costal cartilage calcification in patients undergoing rhinoplasty.

Two reviewers jointly assessed bilateral 6th-8th costal cartilages from 183 rhinoplasty patients (1,098 rib segments) on preoperative chest radiographs, grading calcification (0-4) and classifying morphological pattern (marginal, granular, or central). Multivariable logistic regression identified independent predictors of calcification presence and severity.

Costal cartilage calcification (grade ≥1) was present in 54.1% of segments, with significantly higher prevalence (62.9% vs 46.6%, P < 0.001) and severity in females than males. Calcification was predominantly marginal in males (95.4%), whereas 15.1% and 17.6% of females showed granular and central patterns, respectively. Severe calcification (grade ≥3) peaked unexpectedly in the 40-49-year group (25.8%) rather than in older patients. On multivariable analysis, female sex (OR 3.01; 95% CI, 1.11-8.12) and age 40-49 years (OR 6.28; 95% CI, 1.69-23.36) were independent predictors of severe calcification.

Routine rib series imaging should be considered even in younger candidates to optimize donor site selection and avoid unexpected intraoperative findings.