Adson-Brown (A-B) is the most appropriate forceps for grasping cartilages in rhinoplasty. Its multi-teeth tip prevents cartilage damage or bounce. However, cartilage grasping with A-B forceps ensures just one grasp at a time from a single point.During several parts of rhinoplasty, especially while stabilizing 2 separate cartilages to each other, at least 2 grasping points are needed for optimum stabilization. This is made possible by using 2 separate A-B forceps or by utilizing injector needle(s).
DESIGN AND UTILIZATION
To fill the need for 2 point fixation to occur easily, the A-B forceps has been modified by creating a double grasping tip (Each tip length/width: 20 mm/2 mm; Groove length/width: 19 mm/2 mm; Total length 125 mm). This design ensures double grasping with better stabilization and can also be called Cerci-Adson-Brown (C-A-B) forceps. This double grasp can secure the approximation of 2 separate cartilages, and additionally it can ease suturing of these 2 cartilages to each other through the groove existing between the grasping tips. Examples of 2 separate cartilage fixations with use of C-A-B forceps can be given as fixation of 2 pieces of septal cartilage grafts to build a stronger strut graft (Fig. 1, SDC1), fixation of the spreader grafts to the septum, fixation of second cap graft over the previous one. (See video, Supplemental Digital Content 1, which displays fixation of 2 pieces of septal cartilage grafts to build a stronger strut graft with the aid of Cerci-Adson-Brown forceps. This video is available in the “Related Videos” section of the Full-Text article at PRSGlobalOpen.com or at http://links.lww.com/PRSGO/A867.)
Fig. 1.
Fixation of different pieces of septal cartilage grafts to build a strong strut graft.
Fixation of different pieces of septal cartilage grafts to build a strong strut graft.See video, Supplemental Digital Content 1, which displays fixation of 2 pieces of septal cartilage grafts to build a stronger strut graft with the aid of Cerci-Adson-Brown forceps. This video is available in the “Related Videos” section of the Full-Text article at PRSGlobalOpen.com or at http://links.lww.com/PRSGO/A867.It can also be used during transdomal suture placement (Fig. 2) and for carving of any cartilage graft with better stabilization.
Fig. 2.
Holding the dome during transdomal suture placement.
Holding the dome during transdomal suture placement.A thick piece of cartilage can be sectioned and thinned to 2 equal halves with the guidance of this forceps. It can be grasped with this double tipped forceps and can be cut to 2 equal halves by simply inserting a scalpel through the groove existing between the tip pairs without any inadvertent tilting of the scalpel toward 1 side, which may cause asymmetric thicknesses of the graft pieces.
RELATED DEVICES
In literature I saw “Humayun-Adson-Brown” forceps designed with a similar idea.[1] However, it is a single pair of tipped forceps with teeth like A-B and additionally a 4 mm groove has been created in the middle part of the teeth. A 4 mm groove may ease suture placement but cannot provide a 2 point bite for better stabilization and cannot guide a scalpel to cut a thick cartilage into 2 halves.In literature I saw a “precise and rapid costal cartilage graft sectioning device.” Although it is a wisely designed device for shaping of costal cartilage graft, it is not practical in use as it carries too many parts.[2] This device can process the cartilage pieces if the carved graft has been inserted in the device only in vertical position. Nevertheless, oblique splitting of the costal cartilage is better to prevent warping of the graft pieces.[3] The C-A-B forceps can also grasp the costal cartilage obliquely to obtain oblique-split graft.
CONCLUSION
C-A-B forceps is a useful new forceps design that can ease cartilage graft stabilization, suture fixation, and sectioning.
Fig. 1.
Fig. 2.