Rib cartilage is the workhorse autogenic material for laryngeal airway expansion surgery. Most usually one will use the right-sided 5th or 6th rib as the donor site. A 2.5 cm incision is made directly over the rib, in the inframammary crease from the lateral aspect of the nipple to the sternal xyphoid process. Subcutaneous fat is removed. The overlying intercostal muscles are dissected up away from the rib, divided, and retracted– effectively exposing the rib. Perichondrium is sharply incised on the superior and inferior borders of the rib. A posterior tunnel is elevated in asub-perichondrial plane using blunt instruments, just medial to the osseocartilagenous (OC) junction. A Doyen elevator is inserted into the tunnel and the rib is transected right at the OC junction. The rib is then elevated from lateral to medial in the subperichondrial plane.
Such a manuever ensures that the plueral space will not be entered, protecting the pleural membrane from injury.
Once the rib has been elevated to the sternal attachment, it is completely released. The pleura is inspected directly to confirm it has not been injured. The wound is filled with normal saline and 30 cm of water pressure valsalva is applied by the anesthesiologist for 30 seconds, to ensure no air is escaping the lung. The wound is closed in layers over a rubber band drain placed in a dependent position.
One should be able to harvest 2.5-3 cm of cartilage. Post-operatively a chest radiograph is obtained to rule out pneumothorax