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Wayne I. Contemporary Male Rhinoplasty Surgery. Facial Plast Surg Clin North Am 2024; 32:399-408. [PMID: 38936997 DOI: 10.1016/j.fsc.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
In general, fewer male patients seek rhinoplasty surgery than females. The surgical principles are similar in both populations with some special anatomic considerations that will need attention. There is a higher rate of body dysmorphic syndrome in males seeking rhinoplasty as well as greater challenges with patient satisfaction, and the consultation process needs to be thorough and deliberate when undertaking aesthetic surgery in this population to maximize positive outcomes.
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Affiliation(s)
- Ivan Wayne
- Department of Otorhinolaryngology, University of Oklahoma College of Medicine, Oklahoma City, OK, USA; W Aesthetics, 10001 Broadway Extension, Suite A, Oklahoma City, OK 73114, USA.
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2
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Kowalski HR, von Sneidern M, Wang RS, Laynor G, Lee JW. Complications of Nasal Tip Stabilizing Grafts with Autologous Versus Irradiated Homologous Costal Cartilage in Septorhinoplasty: A Systematic Review. Facial Plast Surg Aesthet Med 2024. [PMID: 38669105 DOI: 10.1089/fpsam.2023.0337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
Background: Complications associated with the use of autologous and homologous costal cartilage for nasal tip stabilizing grafts in septorhinoplasty are not well understood. Objective: The authors review current literature to evaluate complications associated with autologous and irradiated homologous costal cartilage (IHCC) used for septal extension and columellar strut grafts in rhinoplasty. Method: A comprehensive literature search was conducted in PubMed, Embase, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov. Articles that used autologous or IHCC for either septal extension or columellar strut grafts in patients undergoing septorhinoplasty were included. The primary outcomes analyzed were postoperative complications. Results: A total of 14 studies representing 1358 patients were included. The pooled complication rate was 4.7%. IHCC grafts were associated with a higher incidence of complications (n = 21, 5.0% vs. n = 44, 4.6%, p = 0.01). Resorption was the most common complication in the IHCC group and occurred significantly more frequently than in the autologous costal cartilage (ACC) group (n = 10, 2.4% vs. n = 5, 0.49%, p = 0.002). Deviation/warping was the most common complication in the ACC group (n = 16, 1.7%). Conclusion: Autologous and irradiated homologous costal rhinoplasties remain safe procedures. The increased incidence of resorption associated with IHCC grafts should be considered during preoperative planning.
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Affiliation(s)
- Haley R Kowalski
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Manuela von Sneidern
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Ronald S Wang
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Gregory Laynor
- Medical Library at New York University Grossman School of Medicine, New York, New York, USA
| | - Judy W Lee
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Head and Neck Surgery, New York University Grossman School of Medicine, New York, New York, USA
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3
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Ozdemır M, Akkoç MF, Tunık S. Investigation of Two New Grafting Techniques for Dorsal Augmentation Rhinoplasty: An Experimental Study with New Zealand White Rabbits. Aesthetic Plast Surg 2024:10.1007/s00266-024-03949-8. [PMID: 38532200 DOI: 10.1007/s00266-024-03949-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/21/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION Cartilage is an important source in supporting the structure of the nose for dorsal augmentation rhinoplasty. However, it is known that its viability is not always on the ideal level. Various wrapping materials are used to increase the strength of cartilage. Donor site morbidity, which develops following the harvesting of both cartilage and fascia as one such cover material, has attracted interest in recent years. OBJECTIVE In this study, we aimed to investigate the potential of dermis and tendon autografts as alternatives to fascia and cartilage. MATERIAL AND METHOD The sample of the study included 16 New Zealand white rabbits. The right auricular cartilage of all rabbits was amputated, and it was transformed into diced cartilage autografts. The dermis autografts from the right gluteal areas of the rabbits were deepithelialized, and lumbosacral fascia autografts were harvested from the same incision. Additionally, the Achilles tendon of each rabbit was harvested and transformed into diced tendon autografts. Four different autografts were embedded under the skin of each rabbit from 4 different pouches opened in the back of the rabbit. These autografts included diced cartilage alone (Intervention 1), fascia-wrapped cartilage (Intervention 2), dermis-wrapped cartilage (Intervention 3) and fascia-wrapped tendon (Intervention 4) autografts. RESULTS Intervention 1 had the most irregular appearance, the outcomes in Intervention 4 were volumetrically smaller and softer. Connective tissue formed between the diced pieces in all interventions, and it was observed that the dermis and fascia had a capsule-like appearance, and their viability was preserved. The differences between the initial and final measurements of the volumes of interventions 1, 2 and 3 were statistically significant (p < 0.05). There was no significant difference between the initial and final volumetric measurements of intervention 4 (p > 0.05). More peripheral proliferation was observed in the interventions of fascia-wrapped and dermis-wrapped diced cartilage compared to the other interventions. The intervention including fascia-wrapped diced tendon grafts had displayed more fibrosis, fragmentation and collagen fibers, while it showed a lower amount of elastic fiber. There were no significant differences among the intervention in terms of other histological parameters. CONCLUSION Tendon autografts may be a good option for dorsal augmentation rhinoplasty as they are easily harvested and have minimal donor site morbidity. Dermis autograft usage is more advantageous than fascia usage in terms of accessibility and convenience. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Mehmet Ozdemır
- Department of Plastic Reconstructive and Aesthetic Surgery, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Fatih Akkoç
- Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Dicle University, Diyarbakir, Turkey.
| | - Selcuk Tunık
- Department of Histology and Embryology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
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Zhang Z, Wu J, Yu Z, Zhang Y, Zhang J, Song B. Novel "Z" Technique to Overcome Warping of Costal Cartilage. Aesthet Surg J 2023; 44:20-25. [PMID: 37540898 DOI: 10.1093/asj/sjad244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Dorsal augmentation with costal cartilage is generally used for aesthetic rhinoplasty. However, the tendency of costal cartilage to warp may jeopardize the aesthetic outcome. OBJECTIVES The aim of this study was to describe a new "Z" technique to overcome the warping of costal cartilage after implantation and to evaluate the efficacy of this technique in vitro. METHODS A total of 31 pairs of porcine costal cartilage grafts (40 mm × 10 mm × 5 mm) were obtained and kept in Dulbecco's Modified Eagle Medium (Sigma-Aldrich, St. Louis, MO) to maintain cell viability. Paired grafts were obtained and randomly allocated for preparation by the accordion technique and the "Z" technique. Standardized photographs (obtained immediately after operation and at 4 weeks) were used for warping analysis. Biomechanical testing was performed to measure the graft's capacity to resist deformation by an external force. RESULTS Cell viability of the grafts at 4 weeks was comparably good in the accordion group and the Z group (61.88% ± 4.47% vs 67.48% ± 7.03%, P = 0.55). Warping angle was comparable between the 2 groups (P > 0.01). The capacity to resist external force was significantly better in the Z group; the force needed to cause deformation was 3.98 ± 1.04 N in the Z group vs 1.61 ± 0.47 N in the accordion group in lateral view (P < 0.0001), and 1.33 ± 0.41 N vs 0.96 ± 0.24 N, respectively, in frontal view (P = 0.0013). CONCLUSIONS The "Z" technique appears to be a simple and effective method to minimize the tendency of costal cartilage to warp after implantation.
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Wan R, Weissman JP, Williams T, Ullrich PJ, Joshi C, Huffman K, Galiano RD. Prospective Clinical Trial Evaluating the Outcomes Associated with the Use of Fresh Frozen Allograft Cartilage in Rhinoplasty. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5315. [PMID: 37799442 PMCID: PMC10550040 DOI: 10.1097/gox.0000000000005315] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 08/16/2023] [Indexed: 10/07/2023]
Abstract
Background There are different types of grafts for rhinoplasty, each with certain advantages and disadvantages. Fresh frozen cadaveric costal allograft (CCA) provides an alternative to rhinoplasties. The aim of this study was to compare the outcomes of fresh frozen CCA and traditional autologous costal cartilage in cosmetic and reconstructive rhinoplasty procedures. Methods This is a prospective, single-center, nonrandomized, open-label clinical trial. Objective assessment to evaluate warping, resorption, and displacement of the cartilage was achieved by measuring the differences of standardized values (deviation angle, nasofrontal angle, total facial convexity, nasofacial angle, and nasolabial angle) obtained at 6-months and 12-months postoperative follow-up on standard two-dimensional photographs (Δ = ∣measurement6 - measurement12∣). Subjective assessment was measured by the FACE-Q assessment. Results Fifty eligible patients between March 2017 and October 2020 were included. The average age was 43.9 ± 16.6 years and the mean follow-up period was 14.8 months. In the control group, the changes (Δ) in the deviation angle and nasolabial angle were greater than in the CCA group (P < 0.05). In the CCA group, the mean score of satisfaction with nose improved at 6 months and 1 year postoperatively (P < 0.05). The mean score of satisfaction with nostrils and overall facial appearance also increased in the CCA group at 6 months postoperatively (P < 0.05). Six patients from the CCA group and 10 patients from the control group experienced postoperative complications. Conclusions Fresh frozen CCA is a safe and reliable source of rhinoplasty grafts. It is aseptic, readily available, and free of donor site complications.
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Affiliation(s)
- Rou Wan
- From the Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minn
| | - Joshua P. Weissman
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Tokoya Williams
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Peter J. Ullrich
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Chitang Joshi
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Kristin Huffman
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Robert D. Galiano
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
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6
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Storck K, Kotz S, Riedel F, Veit JA. Complications Associated with Alloplastic Materials in Rhinoplasty and Their Operative Management. Facial Plast Surg 2023. [PMID: 37709291 DOI: 10.1055/s-0043-1772846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
Whereas rhinoplasty with a reduction of the dorsum and modification of the tip is a common procedure among Caucasians, augmentation of the dorsum remains a challenge in Asians. Choice of the ideal grafting material for dorsal augmentation is a matter of preference and remains under discussion. Autologous and alloplastic materials have their advantages and disadvantages. We report our experiences of the extrusion of alloplastic materials and their management. We report of 18 patients, who had rhinoplasty in the past for dorsal augmentation with alloplastic material. Augmentation rhinoplasty was performed in Asia (n = 15) and Germany (n = 3). All cases showed recurrent signs of foreign body infection and/or partial extrusion and therefore underwent revision surgery in our centers. Once all patients had been successfully treated with antibiotics, we performed a one-stage revision rhinoplasty with explantation of the alloplastic material and subsequent reconstruction with autologous rib cartilage. The nasal dorsum was augmented with either solid rib cartilage grafts, diced cartilage in fascia, or free diced cartilage in platelet-rich fibrin. All patients received pre-, peri-, and postoperative antibiotics. The outcome was screened via clinical examination, ultrasound examination pre- and postoperatively, two-dimensional/three-dimensional (3D) imaging, and magnetic resonance imaging scans.Alloplastic augmentation of the nasal dorsum runs the risk of foreign body reaction, recurrent infections, uncontrolled scarring, and unsatisfying long-term results. We have obtained a series of aesthetically and functionally satisfying results after single-stage revision surgery with autologous cartilage and demonstrate a variety of novel postoperative screening tools including 3D imaging and high-frequency ultrasound. LEVEL OF EVIDENCE: N/A.
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Affiliation(s)
- K Storck
- Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum Rechts der Isar, TU Munich, Munich, Germany
| | - S Kotz
- Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum Rechts der Isar, TU Munich, Munich, Germany
| | - F Riedel
- Department of Otorhinolarnygology, HNO-Zentrum Rhein-Neckar, Mannheim, Germany
| | - J A Veit
- Department of Otorhinolarnygology, Praxis für Nasenchirurgie München, Munich, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Mannheim, Mannheim, Germany
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Georgolios A, Cooper DJ, Tham T. Diagnosis and Management of Common Presentations of Posttraumatic Nasal Deformity: A Narrative Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4879. [PMID: 36936464 PMCID: PMC10019120 DOI: 10.1097/gox.0000000000004879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 01/23/2023] [Indexed: 03/18/2023]
Abstract
Posttraumatic nasal deformity (PTND) is a surgical challenge for the otolaryngologist and plastic surgeon. Various classifications and management algorithms have been proposed without reaching much consensus in terms of definition and management. Methods We present a narrative review aimed to define PTND and consolidate current knowledge regarding its diagnosis, subtypes, and treatment options. Results This report is a clinical overview of PTND. We also review recent studies that characterize different osteotomy approaches and techniques used for patients with PTND. Conclusions By providing a summary of the main challenges for PTND, we aim to add context to its variable presentation. We hope this broad overview will reinforce more effective communication between providers and promote patient understanding in order to ensure favorable long-term outcomes.
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Affiliation(s)
| | - Dylan J. Cooper
- Department of Otolaryngology-Head and Neck Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, N.Y
| | - Tristan Tham
- Department of Otolaryngology-Head and Neck Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, N.Y
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Auricular Framework Construction Using Cadaveric Costal Cartilage in Type III Microtia: Preliminary Results. J Craniofac Surg 2023; 34:381-386. [PMID: 36102899 DOI: 10.1097/scs.0000000000008845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 05/10/2022] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Non/minimally irradiated Cadaveric Costal Cartilage (NCCC) is commonly used for grafts in nasal reconstruction; however, no information exists on its use in total ear reconstruction for type III microtia. In this case series we describe preliminary results from the novel use of NCCC for auricular framework construction in 7 ear reconstructions. METHODS Patients requiring total ear reconstruction from August 2020 to October 2021 were eligible and underwent ear reconstruction using NCCC from MTF Biologics (Edison, NJ). Patients were evaluated for surgical site infection, skin necrosis, cartilage exposure, warping, and resorption during regular follow up visits. RESULTS Seven ears were reconstructed using NCCC across 5 patients with type III microtia. Patients ranged from 5 to 51 years old at the time of surgery. Follow up time ranged from 12 to 78 weeks (mean: 46 wk). No patients experienced surgical site infections or significant cartilage resorption. All procedures were done outpatient, total time under anesthesia was <90 minutes in 5/7 cases and postoperative narcotics for pain management were not needed in 5/7 cases. Complications included minor skin necrosis that was repaired via primary closure, construct exposure in the immediate postoperative period, which was successfully salvaged with a local flap, and explantation of one construct after reconstruction for a complicated revision surgery involving a previous temporoparietal fascial flap. CONCLUSION NCCC serves as an immediately available alternative to alloplastic and autologous materials for construction of auricular frameworks during ear reconstruction. Longer follow up times and a larger sample size will further elucidate long-term efficacy.
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9
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Laverty RB, Morris E, Brooks DI, Hohman MH, Teixeira J. Biochemical Compositional Analysis of Cadaveric Rib Cartilage. Facial Plast Surg Aesthet Med 2023; 25:44-48. [PMID: 34860118 DOI: 10.1089/fpsam.2021.0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background: Cadaveric rib is used as a cartilage source for reconstructive rhinoplasty in patients who lack sufficient native septal cartilage; however, these grafts are known to warp. Objective: To measure and compare the biochemical properties of cadaveric rib as related to age, gender, and cortical versus core location. Methods: Seven cadaveric rib cartilage specimens were obtained and sectioned into cortical and core segments. Biochemical assays were used to determine total collagen and sulfated glycosaminoglycan (sGAG) content. Results: Collagen was present in higher amounts in cortical segments than core samples (72.8 ± 35.14 vs. 37.3 ± 16.99 μg/mgww, p = 0.0005). sGAG was also shown to be more prevalent in cortical segments (25.47 ± 11.59 vs. 12.17 ± 7.15 μg/mgww, p < 0.0001). The concentrations of collagen and sGAG demonstrated a positive correlation (R2 = 0.44, p = 0.0004). Collagen and sGAG content decreased with the age of the donor (p = 0.001 and p < 0.0001, respectively), but donor gender did not appear to affect collagen or sGAG content (p = 0.62 and p = 0.43, respectively). Conclusion: Collagen and sGAG content was higher in cortical segments of cadaveric rib cartilage than in core segments, and higher in samples from younger cadavers as well.
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Affiliation(s)
- Robert B Laverty
- Department of Surgery, Brooke Army Medical Center, JBSA Fort Sam Houston, Texas, USA
| | - Elena Morris
- Department of Research Programs, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Daniel I Brooks
- Department of Research Programs, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Marc H Hohman
- Department of Otolaryngology, Madigan Army Medical Center, Tacoma, Washington, USA
| | - Jeffrey Teixeira
- Department of Otolaryngology, Madigan Army Medical Center, Tacoma, Washington, USA
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Acharya V, Ng J, Navaratnam A, Rennie C, Clarke P. A novel technique to repair orbital roof defects: irradiated homologous cadaveric rib (Tutoplast ®) graft in a recurrent frontal sinus ossifying fibroma. J Surg Case Rep 2022; 2022:rjac535. [PMCID: PMC9682098 DOI: 10.1093/jscr/rjac535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 10/31/2022] [Indexed: 11/24/2022] Open
Abstract
Ossifying fibroma in the fronto-ethmoidal sinuses is a rare, benign condition. In symptomatic cases, surgical excision is often undertaken and bony defects may be repaired using alloplastic grafts. We present a novel method of repairing an orbital roof defect using irradiated homologous cadaveric rib (Tutoplast ®) graft, overlaid with a pericranial flap. The patient made an excellent recovery, concluding that it is a viable and safe option with lower morbidity.
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Affiliation(s)
- Vikas Acharya
- Correspondence address. Department of ENT Surgery, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London W6 RF, UK. Tel: 020 3311 1234; Fax: 020 3311 1234; E-mail:
| | - Jimmy Ng
- Department of ENT Surgery, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London W6 RF, UK
| | - Annakan Navaratnam
- Department of ENT Surgery, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London W6 RF, UK
| | - Catherine Rennie
- Department of ENT Surgery, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London W6 RF, UK
| | - Peter Clarke
- Department of ENT Surgery, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London W6 RF, UK
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11
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Winkler AA, Chabuz C, McIntosh CND, Lekakis G. The Need for Innovation in Rhinoplasty. Facial Plast Surg 2022; 38:440-446. [DOI: 10.1055/s-0042-1748954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
AbstractRhinoplasty is a challenging surgery and results are not always perfect. There are many obstacles to achieving optimal results. Among these are inadequate instrumentation, the unpredictability of healing, imprecise planning, and many more. Furthermore, selecting patients who can most benefit from surgery is equally important. In this article, some of the more pressing areas of rhinoplasty that need innovation are discussed. From proper patient selection, to advances in education, to the standardization of training programs, to the development of sophisticated implants, the future of rhinoplasty surgery lies in continued creativity and innovation.
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Affiliation(s)
- Andrew A. Winkler
- Department of Otolaryngology, Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Carolyn Chabuz
- Department of Otolaryngology, Head and Neck Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | | | - Garyfalia Lekakis
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
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12
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Optimizing the Use of Autografts, Allografts, and Alloplastic Materials in Rhinoplasty. Plast Reconstr Surg 2022; 150:675e-683e. [PMID: 36041000 DOI: 10.1097/prs.0000000000009372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Understand the autologous graft options available to the rhinoplasty surgeon, including septal cartilage, auricular cartilage, costal cartilage, and bone. 2. Understand the autograft and allograft options available to the rhinoplasty surgeon, including cadaveric costal cartilage, silicone, Medpor, and Gore-Tex. 3. Identify the ideal situations to use each of these implant materials. 4. Understand the advantages and disadvantages of the different autografts, allografts, and implants in rhinoplasty. SUMMARY This review focuses on the graft options available to the modern rhinoplasty surgeon. Autologous options are varied in the quality of cartilage harvested and the morbidity of the donor site. In addition, surgeons should understand the allograft options should autologous grafting be unfeasible or undesirable. New technological advances in processing of allograft cartilage makes this an attractive secondary option.
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13
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Drake VE, Mowery AJ, Nellis JC. An update on rib grafting in rhinoplasty: which rib is right? Curr Opin Otolaryngol Head Neck Surg 2022; 30:209-214. [PMID: 35906971 DOI: 10.1097/moo.0000000000000807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW In revision or posttraumatic rhinoplasty, the quantity and quality of septal cartilage available for grafting is often deficient and auricular cartilage often provides insufficient strength for structural nasal reconstruction. Accordingly, rib cartilage serves as a reliable, abundant source of cartilage for grafting. However, the various sources of rib cartilage carry respective benefits and weaknesses. This review examines recent studies, novel applications and a comparison of the primary sources of rib cartilage, including autologous cartilage, irradiated cadaveric rib and fresh frozen cadaveric cartilage. RECENT FINDINGS Options for rib cartilage include autologous, irradiated cadaveric rib, and more recently, reports on fresh frozen cadaveric cartilage. Studies continue to conclude that autologous and irradiated donor cartilage carry equivalent results, have similar rates of complication and have a comparable cost profile. SUMMARY Regardless of the source, rib cartilage plays an important role in structural rhinoplasty, especially in revision cases. Although the risks, benefits and long-term results of autologous and radiated homologous cartilage have been evaluated in observational studies, fresh frozen rib cartilage will need further follow up before widespread use, although preliminary literature shows promise.
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Affiliation(s)
- Virginia E Drake
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
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14
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Kadakia N, Nguyen C, Motakef S, Hill M, Gupta S. Is Irradiated Homologous Costal Cartilage Reliable? A Meta-Analysis of Complication Rates in Rhinoplasty. Plast Surg (Oakv) 2022; 30:212-221. [PMID: 35990389 PMCID: PMC9389060 DOI: 10.1177/22925503211011973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 02/17/2021] [Accepted: 03/07/2021] [Indexed: 08/03/2023] Open
Abstract
Background: Irradiated homologous costal cartilage (IHCC) may be a convenient, cost-effective and efficient alternative source of graft material in rhinoplasty; however, a systematic review and meta-analysis on this topic have not been previously performed. Objectives: We sought to summarize and pool data on complications associated with the use of IHCC grafting in rhinoplasty. Methods: A systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. We conducted PubMed, Cochrane, Embase, Web of Science database searches, and screened articles using specific inclusion and exclusion criteria. Pooled complication rates were analyzed using a random-effects model. Results: Of the 13 studies that met criteria for systematic review, 11 studies involving 1017 patients, with 1956 IHCC grafts used, were included in the meta-analysis. Mean follow-up across all studies was 47 months. Overall, the pooled complication rates were 1.14% (95% CI: 0.3%-2.0%) for resorption, 0.5% (95% CI: 0.1%-0.9%) for warping, 1.2% (95% CI: 0.3%-2.1%) for infection, 1.0% (95% CI: 0.1%-2.0%) for mobility, and 0.8% (95% CI: 0.1%-1.6%) for graft removal or replacement. No allergic reactions or systemic disease associated with IHCC use were reported in any of the studies. Conclusions: The overall complications associated with IHCC use in rhinoplasty were very low. Costal cartilage allografts are an area of renewed interest that may represent an alternative to autologous costal cartilage grafting in rhinoplasty due to their low complication rates, convenience, cost-effectiveness, and elimination of donor-site complications.
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Affiliation(s)
- Nikita Kadakia
- University of California Riverside School of Medicine, Riverside,
CA, USA
| | - Cyrus Nguyen
- University of California Riverside School of Medicine, Riverside,
CA, USA
| | - Saba Motakef
- The Department of Plastic Surgery, Loma Linda University School of
Medicine, Loma Linda, CA, USA
| | - Michael Hill
- The Department of Plastic Surgery, Loma Linda University School of
Medicine, Loma Linda, CA, USA
| | - Subhas Gupta
- The Department of Plastic Surgery, Loma Linda University School of
Medicine, Loma Linda, CA, USA
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Abstract
BACKGROUND Revision rhinoplasty is undoubtedly one of the most challenging procedures in facial plastic surgery. The complexity is compounded when there is a paucity of native septal cartilage to perform the required framework reconstruction. Harvest of autologous costal cartilage can result in increased operative times and possible secondary-site complications such as contour irregularity, poor scarring, and even pneumothorax. METHODS A retrospective review was conducted of the senior author's (R.J.R.) patients from 2011 to 2020 who underwent primary or revision rhinoplasty. Inclusion criteria consisted of patients with fresh frozen off-the-shelf cartilage used in revision rhinoplasty only with a minimum of 6 months' follow-up. Outcomes for evaluation were warping, resorption, displacement, and infection. RESULTS The authors identified 226 patients who underwent open rhinoplasty with the use of fresh frozen rib cartilage grafts and met inclusion criteria. The mean follow-up period was 12.18 months (range, 6 months to 8 years). The majority of patients had undergone one prior rhinoplasty procedure (54 percent); however, 4 percent of patients had undergone four or more prior procedures on their nose. The overall infection rate was 2.7 percent ( n = 6), with the majority successfully managed with antibiotics alone (2.3 percent). CONCLUSIONS The results in revision rhinoplasty are significantly enhanced with the creation of a stable nasal framework using off-the-shelf, easily accessible, specifically tailored fresh frozen cadaveric rib grafts. The long-term outcomes and complication rate in this 9-year retrospective study demonstrates the safety of fresh frozen rib graft in comparison to autologous or irradiated rib graft. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Zhang Z, Yu Z, Song B. Septal extension graft for correcting short nose in East Asians: Review of autologous cartilage grafts and postoperative stability. Br J Oral Maxillofac Surg 2022; 60:1159-1165. [DOI: 10.1016/j.bjoms.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/10/2022] [Indexed: 11/28/2022]
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17
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Fisher M, Alba B, Ahmad J, Robotti E, Cerkes N, Gruber RP, Rohrich RJ, Bradley JP, Tanna N. Current Practices in Dorsal Augmentation Rhinoplasty. Plast Reconstr Surg 2022; 149:1088-1102. [PMID: 35259145 DOI: 10.1097/prs.0000000000009057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Dorsal augmentation rhinoplasty addresses the aesthetic and functional impairments caused by a deficient nasal dorsum. Augmentation rhinoplasty can be performed using a variety of different surgical techniques and grafting materials that all have distinct advantages and disadvantages. METHODS Grafting materials have unique characteristics, uses, and safety profiles. A detailed overview of various grafting materials and their uses, risks, and benefits is provided. RESULTS Autologous grafting materials include septal cartilage, auricular cartilage, and costal cartilage. These donor sites can provide various amounts of en bloc or diced cartilage. Alternatively, bone may be used when strong structural stability is required, and soft tissue may be used to fill mild to moderate defects. Homologous grafts (e.g., irradiated and nonirradiated rib) and acellular dermal matrices are alternatives to autologous graft with many similar advantages and no need for an additional surgical site. Lastly, alloplastic implants may be successfully used for dorsal augmentation if both patient and surgeon understand their associated risks. CONCLUSION To perform successful dorsal augmentation, surgeons should be familiar with the wide variety of operative approaches and augmentation materials that are currently available and understand their risks, benefits, and uses.
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Affiliation(s)
- Mark Fisher
- From the Division of Plastic and Reconstructive Surgery, Northwell Health, Zucker School of Medicine at Hofstra/Northwell; Division of Plastic and Reconstructive Surgery, University of Toronto; private practice; Cosmed Estetik Plastik Cerrahi; Division of Plastic and Reconstructive Surgery, Stanford University; and Dallas Plastic Surgery Institute
| | - Brandon Alba
- From the Division of Plastic and Reconstructive Surgery, Northwell Health, Zucker School of Medicine at Hofstra/Northwell; Division of Plastic and Reconstructive Surgery, University of Toronto; private practice; Cosmed Estetik Plastik Cerrahi; Division of Plastic and Reconstructive Surgery, Stanford University; and Dallas Plastic Surgery Institute
| | - Jamil Ahmad
- From the Division of Plastic and Reconstructive Surgery, Northwell Health, Zucker School of Medicine at Hofstra/Northwell; Division of Plastic and Reconstructive Surgery, University of Toronto; private practice; Cosmed Estetik Plastik Cerrahi; Division of Plastic and Reconstructive Surgery, Stanford University; and Dallas Plastic Surgery Institute
| | - Enrico Robotti
- From the Division of Plastic and Reconstructive Surgery, Northwell Health, Zucker School of Medicine at Hofstra/Northwell; Division of Plastic and Reconstructive Surgery, University of Toronto; private practice; Cosmed Estetik Plastik Cerrahi; Division of Plastic and Reconstructive Surgery, Stanford University; and Dallas Plastic Surgery Institute
| | - Nazim Cerkes
- From the Division of Plastic and Reconstructive Surgery, Northwell Health, Zucker School of Medicine at Hofstra/Northwell; Division of Plastic and Reconstructive Surgery, University of Toronto; private practice; Cosmed Estetik Plastik Cerrahi; Division of Plastic and Reconstructive Surgery, Stanford University; and Dallas Plastic Surgery Institute
| | - Ronald P Gruber
- From the Division of Plastic and Reconstructive Surgery, Northwell Health, Zucker School of Medicine at Hofstra/Northwell; Division of Plastic and Reconstructive Surgery, University of Toronto; private practice; Cosmed Estetik Plastik Cerrahi; Division of Plastic and Reconstructive Surgery, Stanford University; and Dallas Plastic Surgery Institute
| | - Rod J Rohrich
- From the Division of Plastic and Reconstructive Surgery, Northwell Health, Zucker School of Medicine at Hofstra/Northwell; Division of Plastic and Reconstructive Surgery, University of Toronto; private practice; Cosmed Estetik Plastik Cerrahi; Division of Plastic and Reconstructive Surgery, Stanford University; and Dallas Plastic Surgery Institute
| | - James P Bradley
- From the Division of Plastic and Reconstructive Surgery, Northwell Health, Zucker School of Medicine at Hofstra/Northwell; Division of Plastic and Reconstructive Surgery, University of Toronto; private practice; Cosmed Estetik Plastik Cerrahi; Division of Plastic and Reconstructive Surgery, Stanford University; and Dallas Plastic Surgery Institute
| | - Neil Tanna
- From the Division of Plastic and Reconstructive Surgery, Northwell Health, Zucker School of Medicine at Hofstra/Northwell; Division of Plastic and Reconstructive Surgery, University of Toronto; private practice; Cosmed Estetik Plastik Cerrahi; Division of Plastic and Reconstructive Surgery, Stanford University; and Dallas Plastic Surgery Institute
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Dobratz EJ, Rosines E. Comparison of Decellularized and Gamma-Irradiated Septal and Costal Cartilage Allografts in a Rabbit Model. Facial Plast Surg Aesthet Med 2022; 24:465-471. [DOI: 10.1089/fpsam.2021.0250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Eric J. Dobratz
- Department of Otolaryngology—Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA
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Luan CW, Chen MY, Yan AZA, Tsai YT, Hsieh MC, Yang HY, Chou HH. Complications associated with irradiated homologous costal cartilage use in rhinoplasty: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2022; 75:2359-2367. [PMID: 35354546 DOI: 10.1016/j.bjps.2022.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 01/19/2022] [Accepted: 02/15/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND The use of irradiated homologous costal cartilage (IHCC) as an alternative source of graft material for rhinoplasty remains controversial because of the risk of complications. Herein, we aimed to perform a comprehensive assessment of complications associated with IHCC use in rhinoplasty through a meta-analysis of published studies. METHODS We searched the PubMed, Embase, and Cochrane Library databases to identify eligible published studies, and we evaluated the complication rates of IHCC use in rhinoplasty. Published studies meeting the inclusion criteria included clinical studies involving at least 10 patients and assessing at least 1 postoperative long-term complication of rhinoplasty. Two investigators independently extracted data from the included studies using a standardized form. Meta-analysis was performed using a random-effects model. The main outcomes were the rates of various complications, including the need for revision surgery. RESULTS Ten studies involving a total of 959 patients were analyzed. The complication rates were 2.07% (95% confidence interval [CI], 0.80%-5.23%) for warping, 1.77% (95% CI, 1.10%-2.83%) for infection, 1.34% (95% CI, 0.34%-5.16%) for resorption, 2.13% (95% CI, 0.86%-5.19%) for displacement, 2.99% (95% CI, 1.24%-7.03%) for revision, 0.16% (95% CI, 0.01%-3.25%) for extrusion, and 2.04% (95% CI, 1.02%-4.02%) for avulsion. All the included trials had moderate-to-high methodological quality except for small sample sizes and subjectively reporting of some complications. CONCLUSIONS The overall long-term complication rates associated with IHCC use in rhinoplasty were low. Revision and displacement were the most common complications at the one-year follow-up; surgeons should pay special attention to the risk of these complications. IHCC can serve as a reliable material for rhinoplasty and achieve good patient satisfaction.
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Affiliation(s)
- Chih-Wei Luan
- Department of Otorhinolaryngology-Head and Neck Surgery, LO-Sheng Hospital Ministry of Health and Welfare-Home, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Yu Chen
- Department of Pediatrics, Ditmanson Medical Foundation Chia-Yi Hospital, Chiayi, Taiwan
| | | | - Yao-Te Tsai
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Meng-Chiao Hsieh
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan
| | - Hsin-Yi Yang
- Clinical Medicine Research Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Hsin-Hsu Chou
- Department of Pediatrics, Ditmanson Medical Foundation Chia-Yi Hospital, Chiayi, Taiwan; Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.
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Aldhabaan SA, Hudise JY, Aldosari BF. Comparison Between Using Monocryl Suture and Polypropylene Suture in Closure of Alar Base Excision in Rhinoplasty. Plast Surg (Oakv) 2022; 30:59-62. [PMID: 35096694 PMCID: PMC8793751 DOI: 10.1177/2292550320969651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Rhinoplasty is one of the most common procedures that act as a challenge for consistent outstanding results. Alar base reduction is a technique of rhinoplasty that is prescribed in many conditions. Wound closure requires using of sutures and there are several types of sutures for this purpose; however, good scar results are necessary for patients'satisfaction. AIM To evaluate alar base resection scar results after surgical resection using different types of suturing material. METHODS This is a retrospective cohort study that was conducted at King Abdulaziz University Hospital, Riyadh, Kingdom of Saudi Arabia. The study was performed by reviewing patient's records and performing post-operative photography for patient who underwent alar base resection. The patients were divided into 2 groups, the first group of patients had the alar base wound closed with interrupted Polypropylene 6/0 and the other group wound was closed with monocryl 6/0 sutures. Visual analog scale was used to investigate basal views. RESULTS The study included 80 patients divided into 2 groups, each group included 40 patients, in the first group (Polypropylene group) there were 25% males and 75% females, whereas in the second group (monocryl) there were 15% and 85% males and females, respectively. There were 85% and 82.5% unnoticeable scar reported by the first and second group, respectively; however there was no significant difference between the 2 groups (P = .75). CONCLUSION Both Polypropylene and monocryl sutures result in the same result for closing alar base wound post surgically.
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Affiliation(s)
- Saud A. Aldhabaan
- Department of Otolaryngology, Head and Neck Surgery, King Abdulaziz University Hospital, Riyadh, Saudi Arabia,Saud A. Aldhabaan, Department of Otolaryngology, Head and Neck Surgery, King Abdulaziz University Hospital, King Saud University, Riyadh, Saudi Arabia; King Fisal Medical City of Southern Region, Abha, Saudi Arabia.
| | - Jibril Y. Hudise
- Department of Otolaryngology, Head and Neck Surgery, King Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Badi F. Aldosari
- Department of Otolaryngology, Head and Neck Surgery, King Abdulaziz University Hospital, King Saud University, Riyadh, Saudi Arabia
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21
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Long-Term Resorption Rate of Autogenous Onlay Graft in East Asian Rhinoplasty: A Retrospective Study. Plast Reconstr Surg 2022; 149:360-371. [PMID: 35077410 DOI: 10.1097/prs.0000000000008793] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Autologous material remains the preferred graft material for use in rhinoplasty. However, resorption rates of autografts remain controversial. In addition, long-term follow-up studies on autografts are rare. Thus, the objective of the present study was to access long-term resorption rates of various autologous grafts on the upper nasal third. METHODS Medical records of patients who had undergone septorhinoplasty with dorsal augmentation using autologous tissues between 2009 and 2018 were retrospectively reviewed. Autogenous grafts applied on the nasal dorsum were categorized into three groups: rolled superficial mastoid fascia, diced cartilage wrapped with superficial mastoid fascia, and rolled sacral dermis. Preoperative and postoperative photographs were used to evaluate resorption rates and projection. RESULTS The rolled sacral dermis group showed a steep increase in postoperative projection but a sharp decrease in long-term follow-up projection compared to the other two groups. Among these three groups, there were statistically significant trend differences in rhinion (p < 0.001) and ½ nasion-rhinion point (p < 0.001), but not in nasion. Of these three groups, the rolled sacral dermis group showed the most projection, followed by the diced cartilage wrapped with superficial mastoid fascia group. The resorption rate was the highest in the rolled superficial mastoid fascia group (p < 0.001). Regarding resorption rates in the other two groups, the rolled sacral dermis group had a higher rate than the diced cartilage wrapped with superficial mastoid fascia group. CONCLUSIONS At least 50 percent of resorption was observed in almost all groups in the long term. The choice of graft material and proper decision-making could determine success or failure. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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22
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Starr NC, Creel L, Harryman C, Gupta N. Cost Utility Analysis of Costal Cartilage Autografts and Human Cadaveric Allografts in Rhinoplasty. Ann Otol Rhinol Laryngol 2021; 131:1123-1129. [PMID: 34779266 DOI: 10.1177/00034894211058115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Human cadaveric allograft (HCA) and costal cartilage autograft (CCA) have been described for reconstruction during rhinoplasty. Neither are ideal due to infection, resorption, and donor site morbidity. The clear superiority of 1 graft over the other has not yet been demonstrated. This study assesses comparative costs associated with current grafting materials to better explore the cost ceiling for a theoretical tissue engineered implant. MATERIALS AND METHODS A cost utility analysis was performed. Initial procedure costs include physician fees (CPT 30420), hospital outpatient prospective payments, ambulatory surgical center payments, and fees for the following: rib graft (CPT 20910), hospital observation, and DRG (155) for inpatient admission. Additional costs for revision procedure, included the following fees: physician (CPT 30345), rib graft, hospital outpatient prospective payment, and ambulatory surgical center payments. Total costs under each scenario were calculated with and without the revision procedure. Comparison of total costs for each potential outcome to the estimated health utility value allowed for comparison across rhinoplasty subgroups. RESULTS The mean cost of primary outpatient rhinoplasty using HCA and CCA were $8075 and $8342 respectively. Revision outpatient rhinoplasty averaged $7447 and increased to $8228 if costal cartilage harvest was required. Hospital admission increased the cost of primary rhinoplasty with CCA to $8609 for observational admission and to $13653 for 1 day inpatient admission. Revision CCA rhinoplasty with an inpatient admission complicated by pneumothorax increased costs to $21 099. CONCLUSION Cost of rhinoplasty without hospitalization was similar between HCA and CCA and this cost represents the lower limit of a practical cost for an engineered graft. Considering complications such as need for revision or for admission after CCA due to surgical morbidity, the upper limit of cost for an engineered implant would approximately double.
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Affiliation(s)
- Nicole C Starr
- Department of Otolaryngology Head and Neck Surgery, University of Kentucky, Lexington, KY, USA
| | - Liza Creel
- School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA
| | - Christopher Harryman
- Department of Otolaryngology Head and Neck Surgery, University of Kentucky, Lexington, KY, USA
| | - Nikita Gupta
- Department of Otolaryngology Head and Neck Surgery, University of Kentucky, Lexington, KY, USA
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When Less Is More: A Costal Cartilage-Sparing Technique for Cartilage Graft Harvest in Rhinoplasty. Plast Reconstr Surg 2021; 148:681e-682e. [PMID: 34495909 DOI: 10.1097/prs.0000000000008372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cadaveric Costal Cartilage Grafts in Rhinoplasty and Septorhinoplasty: A Systematic Review and Meta-Analysis of Patient-Reported Functional Outcomes and Complications. J Craniofac Surg 2021; 32:1990-1993. [PMID: 33405456 DOI: 10.1097/scs.0000000000007400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Irradiated cadaveric costal cartilage (CC) has been utilized as an alternative to autologous cartilage (AC) in functional and aesthetic nasal surgery. The impact of graft choice between AC and CC on functional outcomes in rhinoplasty has yet to be studied. A systematic review was performed in PubMed, Embase, and Cochrane databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify comparative studies evaluating the efficacy and safety of CC in nasal surgery. Functional and aesthetic outcomes and complications were reviewed and compared between AC and CC. Meta-analytic comparisons were performed when appropriate using data from comparative studies using a random-effects model. Four studies met inclusion criteria. The indication for surgery was functional in the majority of cases, and 34.6% of cases were revision rhino- or septorhinoplasties. Disparate data across studies prevented meta-analysis on functional outcomes; however, qualitative review of function outcomes demonstrated comparable outcomes between the CC and AC groups. No differences in graft infection, warping, and resorption rates were detected. Analysis of all graft-related complications was higher in the CC group (P = 0.02); however, when AC donor site-related complications were included, no significance between the two groups was observed. In conclusion, limited, high quality data was available for analysis. Of the available studies, this systematic review suggest that the use of AC or CC may lead to comparable results in terms of functional outcomes. More long-term studies directly comparing AC and CC functional outcomes would be welcomed.
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Kim YB, Nam SM, Park ES, Choi CY, Cha HG, Kim JH. Nasal Reconstruction of a Frontonasal Dysplasia via Septal L-Strut Reconstruction Using Costal Cartilage. Cleft Palate Craniofac J 2021; 59:1306-1313. [PMID: 34402319 DOI: 10.1177/10556656211036614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Frontonasal dysplasia (FND) is a rare congenital condition. Its major features include hypertelorism, a large and bifid nasal tip, and a broad nasal root. We present our technique of septal L-strut reconstruction using costal cartilage. DESIGN Retrospective review from June 2008 and August 2017. METHODS Under general anesthesia, 6 patients with FND underwent septal reconstruction using costal cartilage via open rhinoplasty. We reconstructed the nasal and septal cartilaginous framework by placing columellar struts and cantilever-type grafts. RESULTS The patients ranged in age from 6 to 13 years old. All were female. The follow-up period ranged from 8 months to 2 years; we encountered no postoperative complications (infection, nasal obstruction, or recurrence). All patients were satisfied with their nasal appearance. CONCLUSIONS Although the results were not entirely satisfactory from an esthetic point of view, we found that FND can be treated via septal reconstruction with costal cartilage and that the clinical outcomes are reliable and satisfactory. Our approach is a useful option for FND patients.
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Affiliation(s)
- Yong Bae Kim
- WONJIN Plastic Surgery Clinics, Seoul, Republic of Korea
| | - Seung Min Nam
- Department of Plastic and Reconstructive Surgery,26730Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Eun Soo Park
- Department of Plastic and Reconstructive Surgery,26730Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Chang Yong Choi
- Department of Plastic and Reconstructive Surgery,26730Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Han Gyu Cha
- Department of Plastic and Reconstructive Surgery,26730Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Jun Hyun Kim
- Department of Plastic and Reconstructive Surgery,26730Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
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Rogal J, Glasgold A, Glasgold RA. Safety and Efficacy of Non- and Minimally Irradiated Homologous Costal Cartilage in Primary and Revision Rhinoplasty. Facial Plast Surg Aesthet Med 2020; 23:25-30. [PMID: 32522045 DOI: 10.1089/fpsam.2020.0031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
| | | | - Robert A Glasgold
- Private Practice, Princeton, New Jersey, USA.,Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Rutgers University-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Abstract
BACKGROUND Irradiated allogeneic costal cartilage is an alternative option of cartilage graft in patients with insufficient autologous cartilage. However, complications can occur during long-term follow-up. This study investigated whether Tutoplast-processed cartilage, one of the irradiated allogeneic costal cartilages, acts as a scaffold for adipose-derived stem cells and chondrogenesis. METHODS In vitro setting, human adipose-derived stem cells seeded onto Tutoplast-processed cartilage were cultured in chondrogenic medium and observed using a scanning electron microscope. Next, 3 types of irradiated cartilage-including Tutoplast-processed cartilage, undifferentiated stem cells on Tutoplast-processed cartilage (undifferentiated group), and chondrogenic differentiated stem cells on Tutoplast-processed cartilage (chondrogenic group)-were implanted subcutaneously into nude mice. Gross, histologic, and gene expression analyses of Tutoplast-processed cartilages were performed at postoperative weeks 2 and 4. RESULTS Human adipose-derived stem cells subjected to in vitro three-dimensional culture differentiated into chondrocytes and expressed cartilage-specificgenes. Adipose-derived stem cells seeded onto Tutoplast-processed cartilage were differentiated into chondrocytes in chondrogenic medium. In the chondrogenic group, the chondrogenic-differentiated cells attached to the surface of the Tutoplast-processed cartilage were maintained during the follow-up and were distinct from the existing Tutoplast-processed cartilage. Moreover, the chondrogenic group had higher expression of cartilage-specific genes compared with the undifferentiated group. CONCLUSIONS Adipose-derived stem cells seeded onto Tutoplast-processed cartilage underwent chondrogenic differentiation, generating new cartilage, which was maintained after implantation without critical complications. The findings are clinically valuable in terms of overcoming the limitations of irradiated allogeneic costal cartilage, and broaden the surgical options for treatments requiring cartilage.
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28
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Toriumi DM. Choosing Autologous vs Irradiated Homograft Rib Costal Cartilage for Grafting in Rhinoplasty. JAMA FACIAL PLAST SU 2019; 19:188-189. [PMID: 28334413 DOI: 10.1001/jamafacial.2017.0036] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Dean M Toriumi
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago
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29
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Wee JH, Mun SJ, Na WS, Kim H, Park JH, Kim DK, Jin HR. Autologous vs Irradiated Homologous Costal Cartilage as Graft Material in Rhinoplasty. JAMA FACIAL PLAST SU 2017; 19:183-188. [PMID: 28334327 DOI: 10.1001/jamafacial.2016.1776] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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.
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Affiliation(s)
- Jee Hye Wee
- Department of Otorhinolaryngology-Head and Neck Surgery, Bundang Jesaeng General Hospital, Deajin Medical Center, Seongnam, Korea
| | - Sue Jean Mun
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University College of Medicine, Pusan, Korea
| | - Woo Sung Na
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Heejin Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, Korea
| | - Joo Hyun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongguk University College of Medicine, Seoul, Korea
| | - Dong-Kyu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, Korea
| | - Hong-Ryul Jin
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
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Park JH, Mangoba DCS, Mun SJ, Kim DW, Jin HR. Lengthening the short nose in Asians: key maneuvers and surgical results. JAMA FACIAL PLAST SU 2014; 15:439-47. [PMID: 24030660 DOI: 10.1001/jamafacial.2013.95] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Using objective anthropometric measurement, this study reports the outcome of surgical correction of short-nose deformities in Asian patients. OBJECTIVE To present our experience in lengthening the short nose in Asians and report the surgical results. DESIGN, SETTING, AND PATIENTS In this retrospective review, we study the cases of 36 patients who underwent surgical correction of short-nose deformity. The effect of nasal lengthening was analyzed using anthropometric measurement, including nasion to tip-defining point (N-TDP), nasal tip projection (NTP), nasofrontal angle (NFA), and columellar-facial angle (CFA). EXPOSURES Surgical correction of short-nose deformity. MAIN OUTCOME MEASURES The preoperative and postoperative N-TDP, NTP, NFA, and CFA and patient satisfaction. RESULTS The mean postoperative follow-up duration was 29.8 months. The cause of the short nose was congenital in 18 cases and secondary to previous rhinoplasty in 18 cases. Septal tissue, conchal cartilage, costal cartilage, and conchal composite tissue were used as graft materials. The key procedures for lengthening included septal extension graft reinforced with extended spreader, dorsal onlay, and tip grafts. The N-TDP increased by 11.2%, and CFA decreased from 122.6° to 111.1°. The NFA changed from 148.9° to 148.5°. The NTP ratio, measured using the Goode method, decreased from 0.53 to 0.50. The increase of N-TDP was greater in patients undergoing the costal cartilage grafting procedure than in those who received septal or conchal cartilage. All patients were satisfied with the aesthetic results, and there were no serious complications. CONCLUSIONS AND RELEVANCE In Asians, the key maneuvers for lengthening were septal extension graft reinforced with extended spreader and dorsal onlay graft. Rib cartilage provided superior lengthening effect compared with other cartilage. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Joo Hyun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
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Septal perforation repair: mucosal regeneration technique. Eur Arch Otorhinolaryngol 2012; 269:2505-10. [PMID: 22350430 DOI: 10.1007/s00405-012-1964-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Accepted: 02/03/2012] [Indexed: 10/14/2022]
Abstract
A novel method for repair of septal perforations. Fifteen volunteers with symptomatic septal perforations were recruited. Open technique rhinoplasty approach was preferred: auricular conchal cartilage graft with intact perichondrium on both sides was harvested and shaped to fit the perforated site and attached to the septum with absorbable sutures. All margins of the graft were covered with nasal mucosa. The severity of patient symptoms was assessed at preoperation, 3 and 6 months postoperatively via visual analogue scale (VAS). Crust formation, whistling, nasal blockage, epistaxis and overall comfort were evaluated. Mucosal physiology was assessed by nasal mucociliary clearance time. The mean age of the patients was 47.3 years. Average perforation size was 1.86 ± 0.78 cm. 14/15 (93.3%) perforations were repaired, and only one patient required revision surgery. VAS scores improved significantly (p < 0.001). Mean mucociliary clearance time improved from 17.6 ± 3.83 to 10.3 ± 3.30 min and 9.3 ± 3.36 min at 3 and 6 months, respectively. This is a novel, simple and safe method for repairing the deficient mucosal area in septal perforations up to 25 mm in diameter.
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