Safety of Irradiated Homologous Costal Cartilage Graft in Cleft Rhinoplasty.

BACKGROUND: Autologous cartilage grafts have a low risk of infection and extrusion in cleft rhinoplasty. However, harvesting autologous cartilage involves donor-site morbidity and increased time under anesthesia. Irradiated homologous costal cartilage grafts may be an effective alternative. METHODS: A retrospective study was performed on patients with a history of cleft lip who underwent rhinoplasty for cleft nasal deformity at Johns Hopkins Hospital from 2009 to 2018. Patients were excluded if their rhinoplasty did not involve a cartilage graft. RESULTS: One hundred sixty-five cleft rhinoplasties (patient age, 2 to 72 years; 52 percent female) were performed. Median follow-up time was 256 days; 30 percent were revision operations. Ninety-six procedures (58 percent) used irradiated homologous costal cartilage grafts, with the remaining using autologous cartilage. Complications resulted from 18 procedures (11 percent), seven (10 percent) involving autologous cartilage and 11 (12 percent) involving irradiated homologous costal cartilage. Most autologous cartilage complications (86 percent) required operative intervention, versus seven of 11 (64 percent) for irradiated homologous costal cartilage. Complications associated with irradiated homologous costal cartilage included infection (n = 5), warping (n = 2), and extrusion (n = 1), while two patients with autologous cartilage experienced collapse and one each experienced resorption, warping, and hypertrophic donor-site scarring. There was no difference between groups regarding complication rate or complications requiring operative intervention (p = 0.3 and p = 0.5, respectively). CONCLUSIONS: Irradiated homologous costal cartilage grafts are equally safe and effective as autologous cartilage for use in cleft rhinoplasty. These grafts are readily available and eliminate donor-site morbidity. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Safety and Efficacy of Non- and Minimally Irradiated Homologous Costal Cartilage in Primary and Revision Rhinoplasty.

Importance: Despite favorable results with conventionally irradiated homologous costal cartilage, there have been no clinical studies to date evaluating the utility of non- or minimally irradiated homologous costal cartilage (NIHCC) in rhinoplasty. Objective: To evaluate the safety and efficacy of NIHCC in primary and revision rhinoplasty. Design, Setting, and Participants: We conducted a retrospective medical record review of patients undergoing primary and revision rhinoplasty between January 2010 and December 2014. Twenty-six patients who underwent primary or revision rhinoplasty with NIHCC were identified. Patient follow-up ranged from 2 to 43.2 months (mean 15.9 months) at the study took place in a single-center private practice, and surgery was performed by the two senior authors. Twenty-seven consecutive patients who underwent primary or revision rhinoplasty for functional and/or cosmetic concerns with NIHCC were identified. One patient was excluded due to concomitant use of GORE-TEX, leaving 26 patients for retrospective review. Seven patients underwent primary rhinoplasty and 19 patients underwent revision rhinoplasty. Main Outcomes and Measures: The purpose of this study is to demonstrate whether non- or minimally irradiated homologous rib cartilage used for primary and revision rhinoplasty has acceptable rates of warping, resorption, and infection. Results: A total of 26 patients underwent surgery with NIHCC; 20 (77%) were women, and the average patient age was 42 years (median 45 years). A total of 100 NIHCC grafts were used. Seven patients underwent primary rhinoplasty and 19 (73%) patients underwent revision rhinoplasty. The total complication rate related to grafts was 3.6%, which included 2 cases of partial noninfective resorption of 77 palpable or superficial grafts (2.6%), 1 infection of 100 grafts (1.0%), and zero cases of graft mobility and warping. Conclusion and Relevance: Non- or minimally irradiated homologous costal cartilage is safe and effective for grafting in primary and revision rhinoplasty, with low rates of resorption, infection, mobility, and warping. Further larger studies will need to be conducted to determine whether or not the reduced radiation improves outcomes compared with traditionally radiated homologous cartilage.

Autologous vs Irradiated Homologous Costal Cartilage as Graft Material in Rhinoplasty.

IMPORTANCE: Studies comparing surgical results of rhinoplasty using autologous costal cartilage (ACC) and irradiated homologous costal cartilage (IHCC) are rare. OBJECTIVES: To compare the clinical results of major augmentation rhinoplasty using ACC vs IHCC and analyze the histologic properties of both types of cartilage. DESIGN, SETTING, AND PARTICIPANTS: A retrospective clinical study was conducted among patients who had undergone rhinoseptoplasty using ACC or IHCC from January 1, 2009, to December 31, 2014. Patients were followed up for more than 1 year after surgery and the histologic characteristics of ACC and IHCC were compared. The details of the surgical procedures and complications, including warping, infection, resorption, and/or donor-site morbidity, were evaluated by reviewing medical records and facial photographs. Patients' subjective satisfaction with aesthetic and functional results was evaluated using a questionnaire. MAIN OUTCOMES AND MEASURES: The details of the surgical procedures and complications, including warping, infection, resorption, and/or donor-site morbidity; patients' subjective satisfaction with aesthetic and functional results' objective evaluation of surgical outcomes, including symmetry, dorsal height, dorsal length, dorsal width, tip projection, tip rotation, tip width, and overall result; and histologic structures. Objective evaluation of surgical outcomes was graded using the Objective Rhinoplasty Outcome Score, which assessed symmetry, dorsal height, dorsal length, dorsal width, tip projection, tip rotation, tip width, and overall result. Histologic structures were evaluated using hematoxylin and eosin, Masson trichrome, Alcian blue, and Verhoeff elastic stains. RESULTS: A total of 63 patients (27 males and 36 females; mean [SD] age, 30.6 [9.5] years) had rhinoseptoplasty using ACC and 20 (9 males and 11 females; mean [SD] age, 35.4 [15.4] years) had rhinoseptoplasty using IHCC. Among observed complications, only notable resorption occurred more frequently in patients using IHCC (6 [30%]) than with ACC (2 [3%]) (P = .002). In subjective evaluations of aesthetic satisfaction, patients who received ACC showed significantly greater satisfaction (37 of 51 patients [73%] were very satisfied) than did those who received IHCC (6 of 20 [30%]) (P = .001). However, there was no between-group difference in subjective functional outcomes: 4 of 51 patients receiving ACC (8%) and 5 of 20 receiving IHCC (25%) were satisfied (P = .50) and 45 of 51 receiving ACC (88%) and 15 of 20 receiving IHCC (75%) were very satisfied (P = .15). Regarding objective aesthetic outcomes, all scores for both ACC and IHCC were more than 3.1 (between good and excellent). Histologic analyses showed larger, more evenly distributed, uniform chondrocytes and more collagens and proteoglycan contents in ACC than in IHCC. CONCLUSIONS AND RELEVANCE: Compared with patients receiving IHCC, those receiving ACC for rhinoseptoplasty showed superior aesthetic satisfaction; ACC also had less frequent notable resorption. Autologous costal cartilage also had better histologic properties than IHCC did, suggesting it as an ideal graft material with less chance of long-term resorption. LEVEL OF EVIDENCE: 3.