Autologous vs Irradiated Homologous Costal Cartilage as Graft Material in Rhinoplasty

Abstract

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.

Abstract

This cohort study compares the results of major augmentation rhinoplasty using autologous costal cartilage vs irradiated homograft costal cartilage and analyzes the histologic properties of both types of cartilage.

Key Points

Questions

Does autologous costal cartilage or irradiated homograft costal cartilage have a better clinical outcome in augmentation rhinoplasty and what are the histologic properties relevant to the differences?

Findings

In this cohort study of 63 patients who received autologous costal cartilage and 20 patients who received irradiated homograft costal cartilage, notable resorption was less frequent with autologous costal cartilage, with higher subjective patient satisfaction compared with irradiated homograft costal cartilage, but the rates of warping were not different. Autologous costal cartilage showed better histologic properties than irradiated homograft costal cartilage.

Meaning

Autologous costal cartilage may be an ideal material with the least chance of long-term resorption for augmentation rhinoplasty.