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Open Access
CC BY 4.0 · Facial Plast Surg
DOI: 10.1055/a-2731-5948
Original Research

Costal Cartilage Calcification in a Caucasian Population: Machine Learning Recommendations for Chest CT-guided Rhinoplasty Planning

Authors

  • Victor S. van Dam

    1   Department of Otorhinolaryngology, Erasmus Medical Center, Rotterdam, The Netherlands

  • Diako Berzenji

    1   Department of Otorhinolaryngology, Erasmus Medical Center, Rotterdam, The Netherlands

  • Aaike S. van den Berg

    2   Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands

  • Floris V. W. J. van Zijl

    1   Department of Otorhinolaryngology, Erasmus Medical Center, Rotterdam, The Netherlands

  • Andries P. Nagtegaal

    1   Department of Otorhinolaryngology, Erasmus Medical Center, Rotterdam, The Netherlands

  • Bernd Kremer

    1   Department of Otorhinolaryngology, Erasmus Medical Center, Rotterdam, The Netherlands

  • Frank R. Datema

    1   Department of Otorhinolaryngology, Erasmus Medical Center, Rotterdam, The Netherlands
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Abstract

Introduction

Autologous costal cartilage calcification (CCC) can impact the course and long-term results of rhinoplasty. Preoperative information about the presence, severity, and pattern of CCC helps to assess donor site suitability and rhinoplasty planning.

Objective

To use machine learning to identify a sex-specific age threshold beyond which a preoperative chest CT is likely to reveal CCC relevant for rhinoplasty planning.

Study Design

Cross-sectional retrospective study of 662 Caucasian adults.

Methods

Prevalence, severity, and patterns of CCC in ribs five to eight were assessed by three independent reviewers. A machine learning algorithm was used to predict the age threshold beyond which a chest CT scan is beneficial to rhinoplasty planning.

Results

The prevalence of CCC in Caucasian adults was 89.6%. Nearly all individuals over the age of 50 exhibited some form of CCC. In young females CCC was more severe and prevalent in the central core of ribs five to eight compared with age-matched males.

Conclusion

A chest CT is recommended in females over 23 years and males over 40 years. No data-driven recommendations regarding an upper age limit for costal cartilage use could be determined from the data.

Keywords

machine learning - costal cartilage calcification - Caucasian - rhinoplasty


Publication History

Received: 07 July 2025

Accepted: 12 October 2025

Accepted Manuscript online:
27 October 2025

Article published online:
03 November 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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