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Nguyen VS, Kofod T, Nisja E, Hosseini M, Worsaae N. Interpositional arthroplasty using cartilage allografts for treating temporomandibular joint arthrosis: a 3- and 5-year retrospective clinical follow-up study. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:573-579. [PMID: 38570274 DOI: 10.1016/j.oooo.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 02/01/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE To evaluate the effect of arthroplasty using interpositional cartilage allografts in patients with temporomandibular joint (TMJ) arthrosis. STUDY DESIGN This retrospective study included patients treated consecutively between 2007 and 2013 using discectomy and interpositional grafting with lyophilized costal cartilage allograft (Tutoplast) sheets. TMJ pain based on the visual analogue scale (VAS), maximal interincisal opening (MIO), joint tenderness to palpation, crepitus from the affected joint, and postoperative complications were assessed. RESULTS Arthroplasty was performed on 37 joints among 34 patients (28 women; mean age: 54 years); 24 joints underwent simultaneous condyle shaving. At final follow-up (3 [n = 37] or 5 [n = 21] years), we observed reduced mean VAS (from 7.6 to 0.9; P < .001) increased mean MIO (from 32.5 to 41.1 mm; P < .001), number of joints with capsule tenderness (from 30 to 3; P < .001), and percentage of joints with crepitus (from 97% to 75%; P = .008). One joint required reoperation because of interposed cartilage fragmentation. No permanent facial nerve injury or malocclusion occurred after treatment. CONCLUSIONS Interpositional arthroplasty is a relatively simple, moderately invasive, and effective surgical treatment for TMJ arthrosis with few complications. However, long-term outcomes of this treatment, specifically beyond 3-5 years postoperatively, remain unknown.
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Affiliation(s)
- Van Son Nguyen
- Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Thomas Kofod
- Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Even Nisja
- Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mandana Hosseini
- Section of Oral Rehabilitation, Department of Odontology, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Nils Worsaae
- Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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2
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Kinkhabwala CM, Patel KG. Structural Support for Large to Total Nasal Reconstruction. Facial Plast Surg Clin North Am 2024; 32:261-269. [PMID: 38575284 DOI: 10.1016/j.fsc.2024.01.005] [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: 04/06/2024]
Abstract
When large defects of the nose are present, it is imperative to address all 3 layers: the external skin envelope, the osteocartilaginous support, and the inner mucosal lining. The middle structural framework is the primary factor in determining the overall shape of the nose, in addition to facilitating a functional and patent airway. As such, its reconstruction must be robust enough to provide lasting osteocartilaginous support while minimizing disfiguring bulk. The goal is replacement of missing tissue with grafts of similar strength, size, and shape. This article will review approaches to the reconstruction of structural support in large nasal defects.
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Affiliation(s)
- Corin M Kinkhabwala
- Department of Otolaryngology Head and Neck Surgery, Medical University of South Carolina.
| | - Krishna G Patel
- Department of Otolaryngology Head and Neck Surgery, Medical University of South Carolina
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3
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Nikparto N, Yari A, Mehraban SH, Bigdelou M, Asadi A, Darehdor AA, Nezaminia S, Khani M, Hakim LK, Eskandari F, Erfani M, Tebyaniyan H. The current techniques in dorsal augmentation rhinoplasty: a comprehensive review. Maxillofac Plast Reconstr Surg 2024; 46:16. [PMID: 38678507 PMCID: PMC11056355 DOI: 10.1186/s40902-024-00418-9] [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: 12/20/2023] [Accepted: 02/13/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND An essential aspect of rhinoplasty is the enhancement of the nasal dorsal contour by performing dorsal augmentation (DA) rhinoplasty. A wide range of techniques are available for DA as the demand for aesthetic nasal refinement grows. This review aims to provide a comprehensive overview of the current techniques used in DA rhinoplasty. MAIN BODY Research articles on DA rhinoplasty techniques were identified through a comprehensive literature search. Scopus, PubMed, and Web of Science were used as electronic databases. Each database was searched for articles published since its inception. DA rhinoplasty techniques were examined in this literature review. Methodological quality was assessed for the selected studies, and data was extracted to examine materials used, surgical approaches, and reported outcomes for each technique. Various DA methods, including autologous grafts and synthetic implants, are examined in-depth in this review. Comparing approaches can help better understand their respective advantages and limitations. CONCLUSION A wealth of techniques is available for DA rhinoplasty, each with advantages. Patients' nasal anatomy, desired outcomes, and potential risks must be considered by surgeons when determining their surgical approach. DA methods continue to evolve rapidly, creating a need for a thorough understanding of the current landscape to make informed decisions.
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Affiliation(s)
- Nariman Nikparto
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Amir Yari
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kashan University of Medical Sciences, Kashan, Iran
| | - Saeed Hasani Mehraban
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Meysam Bigdelou
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Zanjan University of Medical Sciences, Zanjan, Iran
| | | | - Amirmohammad Arabi Darehdor
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Alborz University of Medical Sciences, Karaj, Iran
| | - Sayna Nezaminia
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Alborz University of Medical Sciences, Karaj, Iran
| | - Mehdi Khani
- Resident of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, School of Dentistry, Tehran University of Medical Science, Tehran, Iran
| | | | - Fateme Eskandari
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Erfani
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Tebyaniyan
- Department of Science and Research, Islimic Azade University, Tehran, Iran.
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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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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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6
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Kadhum M, Khan K, Al-Ghanim K, Castanov V, Symonette C, Javed MU. Fresh Frozen Cartilage in Rhinoplasty Surgery: A Systematic Review of Outcomes. Aesthetic Plast Surg 2024:10.1007/s00266-024-03977-4. [PMID: 38528125 DOI: 10.1007/s00266-024-03977-4] [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: 01/30/2024] [Accepted: 02/27/2024] [Indexed: 03/27/2024]
Abstract
INTRODUCTION Cadaveric fresh frozen cartilage provides an enticing alternative to traditional autologous cartilage grafts. This review provides a systematic analysis of existing literature on the use of fresh frozen rib for in rhinoplasties and focuses on clinical and aesthetic outcomes. METHODS The methodology was designed and registered in the PROSPERO database (CRD42023447166). The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline was used to perform this systematic review. RESULTS Four articles were included, with a total of 554 patients. A total of 477 patients were female (86%). Mean age ranged between 35.8 and 40.6. Mean follow-up ranged from 12.2 to 20.3 months. Only one article had a suitable control (with autologous rib graft). Pooled complications rates were low. Infection occurred in 12 patients (2%), warping in 8 patients (1.4%) and resorption in 3 patients (0.5%). CONCLUSION Fresh frozen cartilage may be a safe and reliable alternative to autologous rib grafts. Complication rates were comparable to previous systematic reviews of autologous graft and irradiated allograft. Overall, patients reported high satisfaction rates with low rates of revision procedures. Further studies are required to assess both clinical and cost effectiveness against the current gold standard (autologous graft). LEVEL OF EVIDENCE III Rhinoplasty. This journal requires that authors assign a level of evidence to each article. 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)
- Murtaza Kadhum
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK.
| | - Karishma Khan
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | | | - Valera Castanov
- London Health Sciences Centre (LHSC), London, ON, Canada
- Division of Plastic and Reconstructive Surgery, Western University, London, ON, Canada
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7
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Drake VE, Smith C, Watkins MO, Rudy SF, Joseph AW, Stucken CL, Brenner MJ, Kim JC, Moyer JS. Outcomes of Autologous Versus Irradiated Homologous Costal Cartilage Graft in Rhinoplasty. Facial Plast Surg Aesthet Med 2024. [PMID: 38502836 DOI: 10.1089/fpsam.2023.0334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Abstract
Background: Autologous costal cartilage (ACC) and irradiated homologous costal cartilage (IHCC) are commonly used in septorhinoplasty when there is insufficient septal cartilage for grafting. Objective: To assess the surgical outcomes of patients who underwent septorhinoplasty with either ACC or IHCC as measured by rates of infection, resorption, warping, and revision rate. Methods: A retrospective analysis of patients who underwent rhinoplasty with ACC or IHCC at a single academic institution was performed. Demographic data, surgical details, antibiotic use, and outcomes, including surgical duration, infection, resorption, warping, and revision rate, were analyzed using Fisher's exact test, chi-squared test, and logistic regression. Results: One hundred forty-three patients were identified. The median age was 48 years (interquartile range: 35-57.5) and 62.2% (n = 89) were female, 61 patients (42.7%) underwent ACC, and 82 (57.3%) IHCC. Revision rate in both groups was similar (ACC = 14.8%, IHCC = 14.6%; p = 0.98). There was no difference in infection rate (ACC = 4.9%, IHCC = 3.7%; p = 0.71). Postoperative deformity and nasal obstruction were the most common indications for revision surgery. Surgical time was shorter with IHCC (p < 0.01). Mean follow-up time was 26.5 months (±25) for ACC, and 16 months (±12) for IHCC. Conclusions: ACC and IHCC are similar in terms of effectiveness and safety in septorhinoplasty.
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Affiliation(s)
- Virginia E Drake
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Livonia, Michigan, USA
| | - Connor Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Livonia, Michigan, USA
| | - Mariel O Watkins
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Livonia, Michigan, USA
| | - Shannon F Rudy
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Livonia, Michigan, USA
| | - Andrew W Joseph
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Livonia, Michigan, USA
| | - Chaz L Stucken
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Livonia, Michigan, USA
| | - Michael J Brenner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Livonia, Michigan, USA
| | - Jennifer C Kim
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Livonia, Michigan, USA
| | - Jeffrey S Moyer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Livonia, Michigan, USA
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8
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Heshemipour Y, Rehman U, Adebayo O, Sarwar MS, Neves S, Kamel Y, Brennan PA. Use of human acellular dermal matrix in rhinoplasty: a systematic review of the literature and meta-analysis. Br J Oral Maxillofac Surg 2024; 62:105-112. [PMID: 38199888 DOI: 10.1016/j.bjoms.2023.11.001] [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] [Received: 09/09/2023] [Accepted: 11/08/2023] [Indexed: 01/12/2024]
Abstract
Alloplastic implants such as acellular dermal matrix (ADM) have been used for various aesthetic and reconstructive purposes since the 1990s. Rhinoplasty addresses both aesthetic and functional nasal impairments, often involving the adoption of grafting materials. Currently, autologous grafts, such as those using septal cartilage, are the gold standard. However, they pose the risk of donor site morbidity, technical challenges, and additional operative time. We review total complications, resorption/re-operation and success rates associated with the use of ADM in rhinoplasty. A literature search was conducted on PubMed, Prospero, DynaMed, DARE, EMBASE and COCHRANE databases. (Registry: CRD42023428019). A total of 462 patients from 15 studies were included, the mean (range) age was 30 (12-65) years, with a female-to-male ratio of 2:1. The most common indications for ADM were for cosmetic (35%, n = 163) and functional rhinoplasty (5%, n = 24). The most common type of ADM used was Alloderm (46%, n = 211). The most common indication for ADM was dorsal nasal augmentation (68%, n = 314). Eleven patients (2%) required revision surgery. The pooled success of ADM in rhinoplasty was 96% (95% CI 94 to 99, p = 0.93; I2 = 0%). 2% of patients developed postoperative complications and no statistically significant difference was seen in complications or success rates when comparing the different types of ADM. ADM in rhinoplasty was associated with fewer complications and re-operation rates, and similar if not less resorption compared to traditional autografts. Therefore, it can be a viable alternative to current autologous grafts in rhinoplasty surgery.
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Affiliation(s)
- Yaldasadat Heshemipour
- Department of Plastic Surgery, Swansea Bay University Hospital, Swansea, United Kingdom.
| | - Umar Rehman
- Department of Plastic Surgery, Chelsea and Westminster Hospital, London, United Kingdom.
| | - Oluwasemilore Adebayo
- Department of Surgery, Lister Hospital, East and North Herts NHS Trust, Stevenage, UK.
| | - Mohammad S Sarwar
- Department of Oral and Maxillofacial Surgery, The Queen Victoria Hospital, East Grinstead, United Kingdom.
| | - Salma Neves
- Imperial College London, London, United Kingdom
| | - Yasmin Kamel
- University of Buckingham, Buckinghamshire, United Kingdom
| | - Peter A Brennan
- Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom.
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Shawky MA, Shawky MA, Zakaria NZ. Safety and Efficacy of Autologous Cartilage Graft in Augmentation Rhinoplasty. Indian J Otolaryngol Head Neck Surg 2024; 76:19-25. [PMID: 38440561 PMCID: PMC10908760 DOI: 10.1007/s12070-023-03999-5] [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: 06/06/2023] [Accepted: 06/16/2023] [Indexed: 03/06/2024] Open
Abstract
Augmentation rhinoplasty or commonly known as "nose jobs" is one of the most common plastic surgical procedures aimed to improve cosmetic appearance. This procedure is considerably safer, less time consuming with faster recovery and immediate cosmetic effect. This procedure needs of highly experienced and well-trained plastic surgeon. According to facial analysis you can select the type of rhinoplasty. Open discussion with the patient to select appropriate surgical technique and its possible risks with your plastic surgeon to ensure the highest level of safety and satisfaction. Autologous grafting materials are safe, efficient and also the first choice for rhinoplasty due to it can survive without a vascular supply, the resorption rate of cartilage is much lower than that of a bone graft. Autologous grafting materials are stable and resistant to infection and extrusion over time so, they are successfully used for dorsal augmentation. To perform successful augmentation rhinoplasty, surgeons should be highly experienced and well-trained and augmentation materials that are currently available and understand their risks, benefits and uses. Autologous cartilage graft regarded as the graft of choice in augmentation rhinoplasty because of their lower rate of infection, rejection, resorption, extrusion, donor site morbidity, easy reshaping.
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10
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Dermody SM, Lindsay RW, Justicz N. Considerations for Optimal Grafting in Rhinoplasty. Facial Plast Surg 2023; 39:625-629. [PMID: 37348541 DOI: 10.1055/a-2116-4566] [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: 06/24/2023] Open
Abstract
A wide variety of grafting materials and techniques can be used to create functional and aesthetic changes in rhinoplasty. Choosing the optimal grafting approach is critical to achieving an optimal patient outcome. We present a review of autografts, allografts, and alloplasts used in primary and revision rhinoplasty and discuss factors that impact graft choice. Autologous grafts serve as the pillar for grafting material in rhinoplasty given their reliable long-term outcomes, low rates of infection, resorption, and extrusion, and ability to provide structural scaffolding as well as contour. Cadaveric allografts can be utilized as a source of grafting material in certain clinical scenarios including revision rhinoplasty and have been shown to be equally safe and effective as autologous grafts while avoiding donor-site morbidity. Alloplasts can prove useful in rhinoplasty in cases of iatrogenic nasal deformities or revision cases. Careful consideration of clinical scenario, patient factors, and outcome goals is necessary to choose the appropriate grafting approach to address functional and cosmetic outcomes.
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Affiliation(s)
- Sarah M Dermody
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Robin W Lindsay
- Department of Otolaryngology-Facial Plastic and Reconstructive Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Natalie Justicz
- Department of Otorhinolaryngology-Facial Plastic and Reconstructive Surgery, University of Maryland, Baltimore, Maryland
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11
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Uto S, Hikita A, Mori D, Sakamoto T, Yano F, Ohba S, Saito T, Takato T, Hoshi K. Subcutaneously Transplanted Fresh Cartilage in Allogeneic and Xenogeneic Immunocompetent Mouse. Tissue Eng Part A 2023; 29:541-556. [PMID: 37548556 DOI: 10.1089/ten.tea.2023.0052] [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: 08/08/2023] Open
Abstract
Cartilage is considered to be immune privileged in general. Clinically, live cells are removed from subcutaneously transplanted allogeneic cartilage mainly for preservation and for infection control. However, because maintaining cartilage feature requires live chondrocyte, it would be beneficial to subcutaneously transplant cartilage with live chondrocyte even if it was allogeneic. We harvested femoral head from 3-week-old male C57BL/6 mice, subcutaneously transplanted to 6-week-old male mice, BALB/c, BALB/c nu/nu, or C57BL/6-Tg (enhanced green fluorescent protein [EGFP] under the control of the CMV-IE enhancer, chicken beta-actin promoter, rabbit beta-globin genomic DNA [CAG promoter]), as allogeneic, allogeneic immunodeficient control, or syngeneic transplantation. We also transplanted cartilaginous particles from human induced pluripotent stem cells derived from human leukocyte antigen homozygous donor to 6-week-old male mice either BALB/c and BALB/c nu/nu as xenogeneic or xenogeneic immunodeficient control. The transplantation periods were 1, 2, 3, 4, 8, 12, and 24 weeks. As the result, we did not observe exposure of the transplant or apparent macroscopic inflammatory in all samples. Histological analysis suggested that the femoral head showed focal ossification and thinning in syngeneic transplantation. In allogeneic transplantation, slight invasion of CD3 (+) T cell and the denaturation of the cartilage were observed, suggesting immune reaction against allogeneic cartilage. In xenogeneic transplantation, slight invasion of CD3 (+) cell and CD4 (+) cell and the structure of the perichondrium-like tissue got unclear, suggesting slight immune reaction against xenogeneic cartilage. Our findings suggest that we should carefully investigate for appropriate procedure to control immune reaction against allogeneic cartilage with live chondrocyte and to maintain its cartilage feature for long time.
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Affiliation(s)
- Sakura Uto
- Department of Sensory and Motor System Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Division of Tissue Engineering, Department of Oral-Maxillofacial Surgery, Dentistry and Orthodontics, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Atsuhiko Hikita
- Division of Tissue Engineering, Department of Oral-Maxillofacial Surgery, Dentistry and Orthodontics, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Daisuke Mori
- Department of Bone and Cartilage Regenerative Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Tomoaki Sakamoto
- Division of Tissue Engineering, Department of Oral-Maxillofacial Surgery, Dentistry and Orthodontics, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Fumiko Yano
- Department of Bone and Cartilage Regenerative Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Shinsuke Ohba
- Division of Clinical Biotechnology, Center for Disease Biology and Integrative Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Department of Cell Biology, Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Taku Saito
- Department of Sensory and Motor System Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Tsuyoshi Takato
- Department of Sensory and Motor System Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- JR Tokyo General Hospital, Shibuya-ku, Tokyo, Japan
| | - Kazuto Hoshi
- Department of Sensory and Motor System Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Division of Tissue Engineering, Department of Oral-Maxillofacial Surgery, Dentistry and Orthodontics, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
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12
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Yan Q, Shi S, Ge Y, Wan S, Li M, Li M. UCHL1 alleviates apoptosis in chondrocytes via upregulation of HIF‑1α‑mediated mitophagy. Int J Mol Med 2023; 52:99. [PMID: 37681473 PMCID: PMC10555477 DOI: 10.3892/ijmm.2023.5302] [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] [Received: 05/18/2023] [Accepted: 08/16/2023] [Indexed: 09/09/2023] Open
Abstract
Stem cell‑based tissue engineering has shown significant potential for rapid restoration of injured cartilage tissues. Stem cells frequently undergo apoptosis because of the prevalence of oxidative stress and inflammation in the microenvironment at the sites of injury. Our previous study demonstrated that stabilization of hypoxia‑inducible factor 1α (HIF‑1α) is key to resisting apoptosis in chondrocytes. Recently, it was reported that Ubiquitin C‑terminal hydrolase L1 (UCHL1) can stabilize HIF‑1α by abrogating the ubiquitination process. However, the effect of UCHL1 on apoptosis in chondrocytes remains unclear. Herein, adipose‑derived stem cells were differentiated into chondrocytes. Next, the CRISPR activation (CRISPRa) system, LDN‑57444 (LDM; a specific inhibitor for UCHL1), KC7F2 (a specific inhibitor for HIF‑1α), and 3‑methyladenine (a specific inhibitor for mitophagy) were used to activate or block UCHL1, HIF‑1α, and mitophagy. Mitophagy, apoptosis, and mitochondrial function in chondrocytes were detected using immunofluorescence, TUNEL staining, and flow cytometry. Moreover, the oxygen consumption rate of chondrocytes was measured using the Seahorse XF 96 Extracellular Flux Analyzer. UCHL1 expression was increased in hypoxia, which in turn regulated mitophagy and apoptosis in the chondrocytes. Further studies revealed that UCHL1 mediated hypoxia‑regulated mitophagy in the chondrocytes. The CRISPRa module was utilized to activate UCHL1 effectively for 7 days; endogenous activation of UCHL1 accelerated mitophagy, inhibited apoptosis, and maintained mitochondrial function in the chondrocytes, which was mediated by HIF‑1α. Taken together, UCHL1 could block apoptosis in chondrocytes via upregulation of HIF‑1α-mediated mitophagy and maintain mitochondrial function. These results indicate the potential of UCHL1 activation using the CRISPRa system for the regeneration of cartilage tissue.
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Affiliation(s)
- Qiqian Yan
- Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, Guangdong 510280
- Guangdong Academy of Stomatology, Guangzhou, Guangdong 510180, P.R. China
| | - Shanwei Shi
- Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, Guangdong 510280
- Guangdong Academy of Stomatology, Guangzhou, Guangdong 510180, P.R. China
| | - Yang Ge
- Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, Guangdong 510280
- Guangdong Academy of Stomatology, Guangzhou, Guangdong 510180, P.R. China
| | - Shuangquan Wan
- Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, Guangdong 510280
- Guangdong Academy of Stomatology, Guangzhou, Guangdong 510180, P.R. China
| | - Mingfei Li
- Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, Guangdong 510280
- Guangdong Academy of Stomatology, Guangzhou, Guangdong 510180, P.R. China
| | - Maoquan Li
- Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, Guangdong 510280
- Guangdong Academy of Stomatology, Guangzhou, Guangdong 510180, P.R. China
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13
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Experimental Study on the Biological Outcome of Auricular Cartilage and Costal Cartilage at Different Time Periods After Autologous Cartilage Rhinoplasty. J Craniofac Surg 2023; 34:785-789. [PMID: 36168117 DOI: 10.1097/scs.0000000000009043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 09/04/2022] [Indexed: 11/26/2022] Open
Abstract
Since autologous cartilage is a good transplant material, it is widely used in various fields of clinical medicine. In this study, we collected clinical specimens obtained at different numbers of years after transplantation and used histologic staining to explore the post-transplantation changes in auricular cartilage and costal cartilage. A retrospective analysis was performed on patients who underwent primary autologous cartilage rhinoplasty and secondary rhinoplasty from 2017 to 2021, and the remaining autologous cartilage tissue after surgery was used for histologic testing. As time progressed after transplantation, the density of costal chondrocytes decreased first and then increased, while the secretion of type II collagen and extracellular matrix both decreased slightly. There was a clear boundary between the cartilage tissue and the surrounding connective tissue, and there was no ingrowth of blood vessels in the cartilage. Auricular cartilage showed a decrease in the integrity of the matrix edge. Moreover, local fibrosis was visible, and vascular ingrowth was observed at the edge of the cartilage. The content of type II collagen first increased and then decreased, and the cell secretion function was lower than that of normal chondrocytes. The results of the study suggest that the histologic outcome of elastic cartilage after transplantation is significantly different from that of hyaline cartilage. Moreover, costal cartilage was more stable than auricular cartilage after transplantation.
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14
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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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15
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Chen H, Wang X, Deng Y. Complications Associated with Autologous Costal Cartilage Used in Rhinoplasty: An Updated Meta-Analysis. Aesthetic Plast Surg 2023; 47:304-312. [PMID: 36071242 DOI: 10.1007/s00266-022-03075-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/16/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To estimate the complications using autologous costal cartilage as grafts in rhinoplasty objectively and systematically with newly published literature. METHODS The literature was searched systematically; included studies were published between July of 1990 and April of 2020. Meta-analysis was performed using a random-effects model. RESULTS Twenty studies involving 1648 patients were included for meta-analysis. The pooled rates of complications were 3.05% of warping (95% CI 1.36-5.19%), 1.2% of resorption (95% CI 0.26-2.56%), 1.45% of infection (95% CI 0.34-3.06%), and 1.53% of contour irregularity (95% CI 0.53-2.88%). The revision rate was 2.25% (95% CI 0.96-3.9%). Regarding of donor-site morbidities, the rate of hypertrophic chest scar was 2.08% (95% CI 0.31-4.83%), and the rate of pneumothorax was 0% (95% CI 0-0.46%). The pooled rates of complications were 9.06% (95% CI 6.13-12.43%) at the recipient site when complications at the recipient site did not include revision surgery, 1.47% (95% CI 0.17-3.56%) at the donor site, and 15.13% (95%CI 11.03-19.69%) overall. The recipient-site adverse event rate was 12.44% (95% CI 8.98-16.33%). CONCLUSIONS Warping was found the most common complication after rhinoplasty with autologous costal cartilage. Revision after rhinoplasty using autologous costal cartilage was increased in these years. Donor-site complications increased the complication rate after rhinoplasty using autologous rib cartilage by 22%. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. 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)
- Hui Chen
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Xiancheng Wang
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
| | - Yiwen Deng
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
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16
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Wright JM, Halsey JN, Rottgers SA. Dorsal Augmentation: A Review of Current Graft Options. EPLASTY 2023; 23:e4. [PMID: 36817363 PMCID: PMC9912050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Background Dorsal augmentation is one of the more complication-prone procedures in rhinoplasty, demanding ample skill and experience to produce an aesthetic and functional result. Numerous autologous grafts, allografts, xenografts, and alloplastic materials have been attempted for augmentation with varying success. Each graft material has its own unique properties that require varying surgical intricacies. The relative risks and benefits of these strategies and materials are also variable and must be weighed. Alloplastic implants are commonly used in eastern countries, but, due to different patient populations and complication profiles, have found less acceptance among western surgeons. Methods A PubMed search was done using the terms "dorsal augmentation rhinoplasty," "liquid rhinoplasty," and "grafts used for rhinoplasty." Publication dates ranging from 1957-2022 were included. Abstracts were screened for relevance, and references from each article were reviewed to identify further articles. Chapters on dorsal augmentation from two key rhinoplasty textbooks were also reviewed. Results A total of 79 articles and 2 textbooks were formally screened; of these, 65 resources were included. Findings were grouped under the headings "facial analysis," "ethnic factors in graft selection," "graft characteristics," "septal cartilage," "auricular cartilage," "costal cartilage," "diced cartilage grafts," "bone grafts," "soft tissue grafts," "nonsurgical/liquid rhinoplasty," and "alloplastic implants." Conclusions Current dorsal augmentation literature focuses on retrospective studies and expert experiences. There are limited quantitative and prospective studies present to delineate an ideal graft. With consistently advancing technology and knowledge of facial aesthetics, a surgeon must maintain a thorough understanding of the current graft and implant options to offer a specialized treatment plan for each deformity and patient.
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Affiliation(s)
- Joshua M. Wright
- Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital; St. Petersburg, FL
| | - Jordan N. Halsey
- Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital; St. Petersburg, FL
| | - S. Alex Rottgers
- Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital; St. Petersburg, FL,Correspondence: S. Alex Rottgers, MD;
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17
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Zhang CQ, Du DJ, Hsu PC, Song YY, Gao Y, Zhu ZZ, Jia WT, Gao YS, Zheng MH, Zhu HY, Hsiang FC, Chen SB, Jin DX, Sheng JG, Huang YG, Feng Y, Gao JJ, Li GY, Yin JM, Yao C, Jiang CY, Luo PB, Tao SC, Chen C, Zhu JY, Yu WB. Autologous Costal Cartilage Grafting for a Large Osteochondral Lesion of the Femoral Head: A 1-Year Single-Arm Study with 2 Additional Years of Follow-up. J Bone Joint Surg Am 2022; 104:2108-2116. [PMID: 36325763 DOI: 10.2106/jbjs.22.00542] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is currently no ideal treatment for osteochondral lesions of the femoral head (OLFH) in young patients. METHODS We performed a 1-year single-arm study and 2 additional years of follow-up of patients with a large (defined as >3 cm 2 ) OLFH treated with insertion of autologous costal cartilage graft (ACCG) to restore femoral head congruity after lesion debridement. Twenty patients ≤40 years old who had substantial hip pain and/or dysfunction after nonoperative treatment were enrolled at a single center. The primary outcome was the change in Harris hip score (HHS) from baseline to 12 months postoperatively. Secondary outcomes included the EuroQol visual analogue scale (EQ VAS), hip joint space width, subchondral integrity on computed tomography scanning, repair tissue status evaluated with the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score, and evaluation of cartilage biochemistry by delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) and T2 mapping. RESULTS All 20 enrolled patients (31.02 ± 7.19 years old, 8 female and 12 male) completed the initial study and the 2 years of additional follow-up. The HHS improved from 61.89 ± 6.47 at baseline to 89.23 ± 2.62 at 12 months and 94.79 ± 2.72 at 36 months. The EQ VAS increased by 17.00 ± 8.77 at 12 months and by 21.70 ± 7.99 at 36 months (p < 0.001 for both). Complete integration of the ACCG with the bone was observed by 12 months in all 20 patients. The median MOCART score was 85 (interquartile range [IQR], 75 to 95) at 12 months and 75 (IQR, 65 to 85) at the last follow-up (range, 24 to 38 months). The ACCG demonstrated magnetic resonance properties very similar to hyaline cartilage; the median ratio between the relaxation times of the ACCG and recipient cartilage was 0.95 (IQR, 0.90 to 0.99) at 12 months and 0.97 (IQR, 0.92 to 1.00) at the last follow-up. CONCLUSIONS ACCG is a feasible method for improving hip function and quality of life for at least 3 years in young patients who were unsatisfied with nonoperative treatment of an OLFH. Promising long-term outcomes may be possible because of the good integration between the recipient femoral head and the implanted ACCG. LEVEL OF EVIDENCE Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Chang-Qing Zhang
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Da-Jiang Du
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Pei-Chun Hsu
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yan-Yan Song
- Department of Biostatistics, Clinical Research Institute, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Yun Gao
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Zhen-Zhong Zhu
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Wei-Tao Jia
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - You-Shui Gao
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Ming-Hao Zheng
- School of Surgery, University of Western Australia, Perth, Australia
| | - Hong-Yi Zhu
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Fu-Chou Hsiang
- School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Sheng-Bao Chen
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Dong-Xu Jin
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Jia-Gen Sheng
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yi-Gang Huang
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yong Feng
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Jun-Jie Gao
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Guang-Yi Li
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Ji-Min Yin
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Chen Yao
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Chen-Yi Jiang
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Peng-Bo Luo
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Shi-Cong Tao
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Chun Chen
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Jin-Yu Zhu
- School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Wei-Bin Yu
- Department of Radiology, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
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Guoyu J, Tao W, Xi Y. Application of methylene blue combined with ropivacaine intercostal nerve block in postoperative analgesia of autologous costal cartilage augmentation rhinoplasty. DIE ANAESTHESIOLOGIE 2022; 71:233-239. [PMID: 36414741 PMCID: PMC9763146 DOI: 10.1007/s00101-022-01222-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 10/05/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To observe the effect of methylene blue combined with ropivacaine intercostal nerve block on postoperative analgesia after autologous costal cartilage augmentation rhinoplasty. METHODS In this study 100 female patients who underwent autologous costal cartilage comprehensive augmentation rhinoplasty in Chongqing Huamei Plastic Surgery Hospital from April to November 2021 were randomly divided into an experimental group and a control group, with 50 cases in each group. In the experimental group methylene blue was combined with ropivacaine intercostal nerve block as patient controlled intravenous analgesia (PCIA), and the control group was ropivacaine intercostal nerve block combined with PCIA. The visual analogue scale (VAS) scores of resting and coughing at 6 h (T1), 24 h (T2), 48 h (T3), 72 h (T4) after surgery were recorded and evaluated. At the same time, the number and times of oral analgesics were recorded as well as nausea, vomiting, burning pain and paresthesia. RESULTS The VAS scores of the experimental group were lower than those of the control group at all time points. At 6 h, 24 h and 48 h after surgery, the VAS score of the experimental group was lower than that in the control group, but the difference was not statistically significant (P > 0.05). The VAS score of calm 72 h after surgery in the experimental group was significantly lower than that in the control group (P < 0.05). The analgesic effect of the two groups was better when they coughed after surgery. At 6 h after surgery, the VAS score of coughing in the experimental group was lower than that in the control group, but the difference was not statistically significant (P > 0.05); At 24 h, 48 h and 72 h after surgery, the VAS score of the coughing state in the experimental group was significantly lower than that in the control group (P < 0.05). CONCLUSION Intercostal nerve block with methylene blue combined with ropivacaine can achieve good postoperative analgesic effects in augmentation rhinoplasty with autologous costal cartilage.
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Affiliation(s)
- Jiang Guoyu
- Department of Anesthesiology, Chongqing Huamei Plastic Surgery Hospital, 400010 Chongqing, China
| | - Wang Tao
- Department of Anesthesiology, Chongqing Huamei Plastic Surgery Hospital, 400010 Chongqing, China
| | - You Xi
- Department of Cosmetology, Chongqing Huamei Plastic Surgery Hospital, 400010 Chongqing, China
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19
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Ri C, Ri H, Yu J, Mao J, Zhao M. Update on Rhinoplasty Research Trends: A Bibliometric Analysis. Aesthetic Plast Surg 2022; 46:2950-2963. [PMID: 35641688 DOI: 10.1007/s00266-022-02910-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 04/23/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Rhinoplasty is one of the most commonly performed aesthetic surgical procedures. The current study aimed to use bibliometric analysis to qualitatively and quantitatively evaluate rhinoplasty research and determine the research trends and hotspots in this field. METHODS Publications on rhinoplasty research were extracted from the web of science core collection database. VOSviewer1.6.18 was used to analyze the co-authorship, co-occurrence, the citations of countries, institutions, authors, and hotspot keywords, and the journals in which the studies were published. RESULTS On April 8, 2022, 11,130 records of rhinoplasty research published between 1945 and 2021 were collected. Most of the retrieved studies were original research articles (n = 8309, 74.65%), and 1950 (17.52%) papers were available in an open-access format. The annual publication output increased annually. Research groups in the USA were the main contributors and had a strong academic reputation in this field. University of California System was the institution with the greatest contribution (4.17%, with 464 publications). Plastic and Reconstructive Surgery (1248 publications, 11.21%) published the most research in this field and was also the most frequently co-cited journal (33,894 citations, total link strength [TLS]: 722,672). R. J. Rohrich (140 publications) was the most prolific author and the most frequently co-cited author (2562 citations, TLS: 56,624). The following rhinoplasty research hotspots were identified: cleft rhinoplasty, nasal reconstruction, nasal tip, revision rhinoplasty, septorhinoplasty, nasal prosthesis, hyaluronic acid, and preservation rhinoplasty. CONCLUSION Our results provide a general overview of the major directions in rhinoplasty research. Preservation rhinoplasty, rib graft, nonsurgical rhinoplasty, hyaluronic acid, FACE-Q, fillers, and three-dimensional technology may be future research hotspots. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. 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)
- CholSik Ri
- The Second Affiliated Hospital of Dalian Medical University, Dalian, China.,The Pyongyang Medical University, Pyongyang, Democratic People's Republic of Korea
| | - HyokJu Ri
- The Second Affiliated Hospital of Dalian Medical University, Dalian, China.,The Pyongyang Medical University, Pyongyang, Democratic People's Republic of Korea
| | - Jiang Yu
- The Dalian Medical University, Dalian, China
| | - JiaXin Mao
- The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - MuXin Zhao
- The Second Affiliated Hospital of Dalian Medical University, Dalian, China.
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20
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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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21
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Davis SJ, Landeen KC, Sowder JC, Kimura KS, Shastri KS, Clymer MC, Stephan SJ. Complications Associated with Use of Porous High-Density Polyethylene in Rhinoplasty. Facial Plast Surg Aesthet Med 2022; 24:337-343. [DOI: 10.1089/fpsam.2021.0090] [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)
- Seth J. Davis
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kelly C. Landeen
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Justin C. Sowder
- Department of Otolaryngology – Head and Neck Surgery, Louisiana State University Health Sciences Center, Baton Rouge, Louisiana, USA
- Center for Facial Plastic and Reconstructive Surgery, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, USA
| | - Kyle S. Kimura
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Karthik S. Shastri
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Facial Plastic and Reconstructive Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mark C. Clymer
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Clymer Facial Plastic Surgery, Brentwood, Tennessee, USA
| | - Scott J. Stephan
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Facial Plastic and Reconstructive Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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22
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Chang Y, Yun H, Choi JW, Suh JM, Jeong WS, Park H, Kang MK, Shin Y, Kim K, Chung CH. Efficacy and safety of equine cartilage for rhinoplasty: a multicenter double-blind non-inferiority randomized confirmatory clinical trial. Arch Craniofac Surg 2022; 23:152-162. [PMID: 36068690 PMCID: PMC9449096 DOI: 10.7181/acfs.2022.00668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022] Open
Abstract
Background The efficacy and safety of equine cartilage as a competent xenograft material for rhinoplasty were evaluated and compared to the outcomes of rhinoplasty using silicone implants. Methods We performed a multicenter, double-blind, non-inferiority, and randomized confirmatory study. Fifty-six patients were randomized 1:1 to the study group (using MegaCartilage-E) and control group (using silicone implants). The Rhinoplasty Outcome Evaluation (ROE) score, photo documentation, Global Aesthetic Improvement Scale (GAIS), and adverse event data were obtained until 12 months after surgery. The primary efficacy, which is the change in ROE score 6 months after surgery, was assessed in the modified intention-to-treat set. The secondary efficacy was evaluated in the per-protocol set by assessing the change in ROE score 6 and 12 months after surgery and nasofrontal angle, the height of the nasion, and GAIS 1, 6, and 12 months after surgery. Results The change in ROE score of the study group was non-inferior to that of the control group; it increased by 24.26±17.24 in the study group and 18.27±17.60 in the control group (p=0.213). In both groups, all secondary outcome measures increased, but there was no statistical difference. In the safety set, treatment-emergent adverse events occurred in 10 patients (35.71%) in the study group and six patients (21.43%) in the control group (p=0.237). There were 13 adverse device events in the study group and six adverse device events in the control group (p=0.515). Conclusion Processed equine cartilage can be used effectively and safely as xenograft material for rhinoplasty.
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Affiliation(s)
- Yongjoon Chang
- Department of Plastic and Reconstructive Surgery, Kangdong Sacred Heart Hospital, Seoul,
Korea
| | - Hyunjong Yun
- Department of Plastic and Reconstructive Surgery, Kangdong Sacred Heart Hospital, Seoul,
Korea
| | - Jong Woo Choi
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Joong Min Suh
- Department of Plastic and Reconstructive Surgery, Kangdong Sacred Heart Hospital, Seoul,
Korea
| | - Woo Shik Jeong
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Hojin Park
- Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Seoul,
Korea
| | - Min Kyu Kang
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | | | - Kuylhee Kim
- Department of Plastic and Reconstructive Surgery, Kangdong Sacred Heart Hospital, Seoul,
Korea
| | - Chul Hoon Chung
- Department of Plastic and Reconstructive Surgery, Kangdong Sacred Heart Hospital, Seoul,
Korea
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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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Navaratnam AV, Stoenchev KV, Acharya V, Saleh HA. The Ageing Nose: Challenges and Solutions. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-022-00408-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Abstract
Purpose of Review
Rhinoplasty has traditionally been considered an elective procedure for younger patients. However, increasingly older patients are undergoing nasal surgery for both functional and aesthetic indications. We provide an overview of the common problems with rhinoplasty in the elderly and the surgical techniques that can be reliably utilised to address them to produce predictable and longstanding results.
Recent Findings
Outcomes from studies of older rhinoplasty patients emphasise the need for a tailored approach that preserves natural structures. However, if reinforced structural support is required, especially in functional cases, grafting techniques such as septal extension grafts, spreader grafts and alar strut grafts are required. Furthermore, special consideration must be made for the nasal skin in older patients, and utilisation of dorsal onlay grafts is often necessary.
Summary
Surgery for the ageing nose is a complex challenge for the rhinoplasty surgeon. Preoperative assessment is critical and must include detailed facial analysis that considers the amplification of facial asymmetry due to the ageing process and an appreciation that expectations in this population may differ from younger patients. A comprehensive understanding of the age-related anatomical changes in the nasal structure and the wide repertoire of operative techniques are required to restore form and function.
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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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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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Starr NC, Zachary Porterfield J, Harryman C, Gupta N. The Use of Autologous and Cadaveric Grafts in Rhinoplasty: A Survey Study. Aesthetic Plast Surg 2022; 46:2398-2403. [PMID: 35043249 DOI: 10.1007/s00266-021-02752-z] [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] [Received: 10/13/2021] [Accepted: 12/22/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Both autologous and cadaveric grafts are often used during rhinoplasty to create volume and provide support. Despite discussion in the literature comparing the efficacy, cost-effectiveness, and complication rates between grafting options, it remains unclear which is the superior choice when considering availability, donor site morbidity, and cost. There is a little description of the current use of these materials amongst facial plastic surgeons. METHODS A 12 question survey was created, and IRB approval was obtained. The survey was distributed to practicing members of the AAFPRS via their membership listserv. RESULTS 178 respondents completed the survey for an overall response rate of 17.5%. The most common rhinoplasty graft types used by respondents were autologous septal cartilage (96.6%), autologous auricular grafts (93.8%), autologous rib graft (ARG) (75.8%), and cadaveric rib graft (CRG) (56.7%). Patient comorbidities and performing more than 50 rhinoplasties per year were positively correlated with use of CRG grafts and concerns about complications and cost were negatively correlated. CONCLUSIONS While autologous septal and auricular cartilage remain the most common graft choices amongst surveyed facial plastic surgeons, a majority utilize cadaveric rib grafts in their practice. Patient comorbidities, surgery volume, concerns about graft complications, and cost were the chief factors associated with use of cadaveric grafts amongst survey respondents. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. 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)
- Nicole C Starr
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center, University of Kentucky, 740 South Limestone, E322, Lexington, KY, 40536, USA
| | - J Zachary Porterfield
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center, University of Kentucky, 740 South Limestone, E322, Lexington, KY, 40536, USA
| | - Christopher Harryman
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center, University of Kentucky, 740 South Limestone, E322, Lexington, KY, 40536, USA
| | - Nikita Gupta
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center, University of Kentucky, 740 South Limestone, E322, Lexington, KY, 40536, USA.
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Abstract
To manage the deficient nasal dorsum, a thorough knowledge of dorsal augmentation techniques should be mastered by the rhinoplasty specialist. Indications for dorsal augmentation may arise in both primary and revision rhinoplasty presentations. To direct operative planning, a complete facial analysis, noting the importance of maintaining overall nasofacial balance, is essential. An array of techniques, including autologous and nonautologous (ie, allogeneic and synthetic) sources, have been used globally-each carrying its own advantages and disadvantages. The authors believe autologous grafts to be the optimal source for dorsal augmentation because of their biocompatibility and ability to produce natural and long-lasting outcomes.
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Affiliation(s)
- Grace J Graw
- Private Practice, Graw Beauty | Dr. Grace, 1515 EL Camino Real, Palo Alto, CA 94306, USA.
| | - Jay W Calvert
- Division of Plastic and Reconstructive Surgery, University of Southern California, 465 North Roxbury Drive, Suite 1001, Beverly Hills, CA 90210, USA
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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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Dholakia SS, Yang A, Kim D, Borchard NA, Chang MT, Khanwalkar A, Lechner M, Nayak JV. Long-Term Outcomes of Inferior Meatus Augmentation Procedure to Treat Empty Nose Syndrome. Laryngoscope 2021; 131:E2736-E2741. [PMID: 33991117 DOI: 10.1002/lary.29593] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/12/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVES/HYPOTHESIS We sought to report the long-term, symptom-focused, prospective outcomes in empty nose syndrome (ENS) patients after undergoing inferior meatus augmentation procedure (IMAP) through use of four validated questionnaires: Empty Nose Syndrome 6-Item Questionnaire (ENS6Q), 22-item Sino-Nasal Outcome Test (SNOT-22), Generalized Anxiety Disorder 7-Item Scale (GAD-7), and Patient Health Questionnaire-9 (PHQ-9). STUDY DESIGN Prospective case series. METHODS A single-center prospective case series was performed for patients diagnosed with ENS who underwent IMAP between July 2017 and February 2020. Diagnosis of ENS was based on the following criteria: 1) reported discomfort with nasal breathing and/or paradoxical nasal obstruction after inferior turbinate reduction, 2) a positive ENS6Q score of at least 11, and 3) a positive cotton test. Questionnaire responses were recorded prior to surgery as well as 1, 3, 6, and 12 months postoperatively. RESULTS Seventeen eligible patients were included. Mean ENS6Q scores were significantly reduced at all postoperative time points (p < .0001, p < .0001, p < .0001, p = .0003). Of the six ENS6Q subdomains, five (suffocation, dryness, sense of diminished airflow, nasal crusting, and nasal burning) were significantly reduced 1-year postoperatively (p < .0001, p = .0004, p = .0136, p = .0114, p = .0080, respectively). SNOT-22 scores were significantly reduced at all time points (p = .0021, p = .0227, p = .0004, and p = .0025). Of the SNOT-22 subdomains, the sleep subdomain was significantly reduced 1-year postoperatively (p = .0432). Low baseline GAD-7 and PHQ-9 scores were recorded at 7 and 9.4, respectively, and although scores at all postoperative time points were reduced, there was no statistical significance. CONCLUSION IMAP via implant of cadaveric rib cartilage provides significant, long-term improvements in ENS-specific and general sinonasal symptoms. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E2736-E2741, 2021.
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Affiliation(s)
- Sachi S Dholakia
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, U.S.A
| | - Angela Yang
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, U.S.A
| | - Dayoung Kim
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, U.S.A
| | - Nicole A Borchard
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, U.S.A
| | - Michael T Chang
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, U.S.A
| | - Ashoke Khanwalkar
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, U.S.A
| | - Matt Lechner
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California, U.S.A
| | - Jayakar V Nayak
- Department of Otolaryngology - Head and Neck Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, U.S.A
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Lin S, He Y, Tao M, Wang A, Ao Q. Fabrication and evaluation of an optimized xenogenic decellularized costal cartilage graft: preclinical studies of a novel biocompatible prosthesis for rhinoplasty. Regen Biomater 2021; 8:rbab052. [PMID: 34584748 PMCID: PMC8473975 DOI: 10.1093/rb/rbab052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/21/2021] [Accepted: 09/02/2021] [Indexed: 12/31/2022] Open
Abstract
On account of the poor biocompatibility of synthetic prosthesis, millions of rhinoplasty recipients have been forced to choose autologous costal cartilage as grafts, which suffer from limited availability, morbidity at the donor site and prolonged operation time. Here, as a promising alternative to autologous costal cartilage, we developed a novel xenogeneic costal cartilage and explored its feasibility as a rhinoplasty graft for the first time. Adopting an improved decellularization protocol, in which the ionic detergent was substituted by trypsin, the resulting decellularized graft was confirmed to preserve more structural components and better mechanics, and eliminate cellular components effectively. The in vitro and in vivo compatibility experiments demonstrated that the decellularized graft showed excellent biocompatibility and biosecurity. Additionally, the functionality assessment of rhinoplasty was performed in a rabbit model, and the condition of grafts after implantation was comprehensively evaluated. The optimized graft exhibited better capacity to reduce the degradation rate and maintain the morphology, in comparison to the decellularized costal cartilage prepared by conventional protocol. These findings indicate that this optimized graft derived from decellularized xenogeneic costal cartilage provides a new prospective for future investigations of rhinoplasty prosthesis and has great potential for clinical application.
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Affiliation(s)
- Shuang Lin
- Department of Plastic Surgery, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang 11004, China.,Department of Tissue Engineering, China Medical University, 77 Puhe Road, Shenyang 110112, China
| | - Yuanjia He
- Department of Stomatology, The Fourth Affiliated Hospital of China Medical University, 4 Chongshan East Road, Shenyang 110033, China
| | - Meihan Tao
- Department of Tissue Engineering, China Medical University, 77 Puhe Road, Shenyang 110112, China
| | - Aijun Wang
- Surgical Bioengineering Laboratory, Department of Surgery, School of Medicine, University of California Davis, Sacramento, CA 95817, USA
| | - Qiang Ao
- Department of Tissue Engineering, China Medical University, 77 Puhe Road, Shenyang 110112, China.,Institute of Regulatory Science for Medical Device, National Engineering Research Center for Biomaterials, Sichuan University, 24 Yihuan Street, Chengdu 610065, China
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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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Efficacy and Safety of Lyophilized Articular Cartilage Matrix as an Injectable Facial Filler. Aesthetic Plast Surg 2021; 45:1266-1272. [PMID: 33216175 DOI: 10.1007/s00266-020-02017-1] [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] [Received: 08/11/2020] [Accepted: 10/11/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of an injectable lyophilized articular cartilage matrix (LACM) which is in the form of cartilage powder that may increase the convenience of use and become unaffected by donor site morbidity as a potential filler. METHODS The safety test was conducted using 20 rabbits with an intravascular embolization model. Commonly used commercial hyaluronic acid (HA), acellular dermal matrix (ADM), polymethyl methacrylate (PMMA), and polylactic acid (PLA) products were selected for comparison of efficacy and adverse effect of LACM. The efficacy test was performed using 30 mice subcutaneous buttock-injection model. Gross assessments of the changes in size of injected materials and histological examinations were conducted. RESULTS Regarding the safety test, in one rabbit in the HA group, complete blurring occurred in the left eye, and necrosis of the posterior auricular artery was observed in one rabbit in the ADM group. In the ADM, severe ecchymosis around the injection sites was observed, and the bruises lasted longer than in the other groups. The LACM exhibited faster bruise resolution. Comparing the changes in size between weeks 4 and 12 in the mouse model, no significant changes in size were observed in the LACM (p = 0.359), HA (p = 0.421), and ADM (p = 0.097), but a significant change was observed in the PMMA (p = 0.001). In the histological examination, LACM exhibited well-demarcated margins with good biocompatibility. CONCLUSION The LACM shows potential as a facial filler according to the in vivo safety and efficacy tests LEVEL OF EVIDENCE V: 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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Septorhinoplasty and Septoplasty: Outcomes of a Large Cohort Using Autologous Versus Homologous Cartilage, 1999-2019. Aesthetic Plast Surg 2021; 45:604-614. [PMID: 33051721 DOI: 10.1007/s00266-020-01986-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 09/19/2020] [Indexed: 01/01/2023]
Abstract
This study describes the complication rate and use of autologous and/or homologous cartilage in a large 20-year cohort of septo(rhino)plasty surgeries in a Dutch hospital, in relation to postoperative complications of septo(rhino)plasty surgery described in previous studies. A retrospective medical chart review was conducted. 2606 patients, mean age 34.7 (± 13.2) and 59.9% male, underwent primary or revision septo(rhino)plasty surgery from 01/01/1999 to 01/09/2019. Follow-up was known in 1384 of 2606 patients (53.1%) with a mean duration of 47.5 months. Complication registration was complete for 1774 patients. The overall complication rate was 270 out of 1774 (15.2%). The use of autologous costal cartilage (ACC) was a risk factor for overall complication with an odds ratio (OR) of 11.1 (95% CI 0.03-0.30; P < 0.01) as compared to 5.9 (95% CI 0.06-0.45; P < 0.01) when using homologous costal cartilage (HCC). Infections were more likely when ACC (5/26 [19.2%]) was used than when HCC (1/28 [3.6%]) was used. Notable resorption of cartilage was more likely when HCC (9/28 [32.1%]) was used than when ACC (1/26 [3.8%]) was used. Both the use of autologous costal cartilage grafts (OR 11.1) and homologous costal cartilage grafts (OR 5.9) lead to an increased risk of complications. When choosing cartilage type for reconstruction in septo(rhino)plasty, it should be taken into account that both ACC and HCC are associated with a higher risk of complications. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. 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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Recent advances in bioprinting technologies for engineering different cartilage-based tissues. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 123:112005. [PMID: 33812625 DOI: 10.1016/j.msec.2021.112005] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/19/2021] [Accepted: 02/23/2021] [Indexed: 02/07/2023]
Abstract
Inadequate self-repair and regenerative efficiency of the cartilage tissues has motivated the researchers to devise advanced and effective strategies to resolve this issue. Introduction of bioprinting to tissue engineering has paved the way for fabricating complex biomimetic engineered constructs. In this context, the current review gears off with the discussion of standard and advanced 3D/4D printing technologies and their implications for the repair of different cartilage tissues, namely, articular, meniscal, nasoseptal, auricular, costal, and tracheal cartilage. The review is then directed towards highlighting the current stem cell opportunities. On a concluding note, associated critical issues and prospects for future developments, particularly in this sphere of personalized medicines have been discussed.
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Taguchi T, Lopez MJ. An overview of de novo bone generation in animal models. J Orthop Res 2021; 39:7-21. [PMID: 32910496 PMCID: PMC7820991 DOI: 10.1002/jor.24852] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 08/27/2020] [Accepted: 09/02/2020] [Indexed: 02/04/2023]
Abstract
Some of the earliest success in de novo tissue generation was in bone tissue, and advances, facilitated by the use of endogenous and exogenous progenitor cells, continue unabated. The concept of one health promotes shared discoveries among medical disciplines to overcome health challenges that afflict numerous species. Carefully selected animal models are vital to development and translation of targeted therapies that improve the health and well-being of humans and animals alike. While inherent differences among species limit direct translation of scientific knowledge between them, rapid progress in ex vivo and in vivo de novo tissue generation is propelling revolutionary innovation to reality among all musculoskeletal specialties. This review contains a comparison of bone deposition among species and descriptions of animal models of bone restoration designed to replicate a multitude of bone injuries and pathology, including impaired osteogenic capacity.
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Affiliation(s)
- Takashi Taguchi
- Laboratory for Equine and Comparative Orthopedic Research, Department of Veterinary Clinical Sciences, School of Veterinary MedicineLouisiana State UniversityBaton RougeLouisianaUSA
| | - Mandi J. Lopez
- Laboratory for Equine and Comparative Orthopedic Research, Department of Veterinary Clinical Sciences, School of Veterinary MedicineLouisiana State UniversityBaton RougeLouisianaUSA
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de Gabory L, Boudard P, Bessède JP, Maillard A, Lacomme S, Gontier E, Durand M, Fricain JC, Bénard A, Bordenave L. Multicenter Pilot Study to Assess a Biphasic Calcium Phosphate Implant for Functional and Aesthetic Septorhinoplasty. Facial Plast Surg Aesthet Med 2020; 23:321-329. [PMID: 32700976 DOI: 10.1089/fpsam.2020.0184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Importance: A validated biomaterial would have several medical advantages in septorhinoplasties requiring a large-volume graft such as avoiding donor site morbidity, making ambulatory surgery possible, and reducing surgical costs. Objective: To assess the safety and efficacy of a ceramic to treat saddle and crooked noses. The main endpoint was the biocompatibility of the implant. The secondary endpoint was its functional and aesthetic efficacy. Design, Setting, and Participants: The nasal septum (NASEPT) study is a pilot multicenter noncomparative prospective phase IIa clinical trial. The biomaterial tested was a biphasic calcium phosphate implant composed of 75% hydroxyapatite and 25% beta tri calcium phosphate. This versatile material can be used to replace septal skeleton when it is absent or nonusable. We included 25 patients with a multifractured osseous and cartilaginous framework after several traumas or surgeries. The implant placement technique was identical to an extracorporeal septoplasty through the external approach. Main Outcomes and Measures: The primary endpoint was the occurrence of expected adverse and severe adverse events. The secondary endpoints were clinical functional and aesthetic results and histological microscopic modifications. Results: Any extrusion, infection, pain, and epistaxis were observed. All implants were placed in a sagittal, straight, and solid position without extralobular depression. Comparisons between pre- and postoperative symptoms showed that nasal comfort (p < 10-4) and quality of life (p < 10-4) were dramatically improved in all patients. The nasolabial angle (p = 0.047) and the columellar projection (p = 0.024) were improved after surgery. Histological data showed little submucosal inflammation at 6 months with well-differentiated epithelium. The mean follow-up was 23 months: three patients underwent revision surgery for functional or aesthetic details and four implants were removed (16%) owing to a foreign body reaction between 17 and 74 months. Conclusion and Relevance: The NASEPT implant meets functional and aesthetic requirements in complex septorhinoplasties but its long-term biocompatibility needs to be improved. It could potentially avoid donor site morbidity.
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Affiliation(s)
- Ludovic de Gabory
- University Hospital of Bordeaux, Department of Otorhinolaryngology, Bordeaux, France.,CHU Bordeaux, CIC 14-01 IT, Bordeaux, France.,University of Bordeaux, Bordeaux, France
| | - Philippe Boudard
- Department of Otorhinolaryngology, Saint Augustin Hospital, Bordeaux, France
| | | | - Aline Maillard
- CHU Bordeaux, Public Health Unit, Clinical Epidemiology Unit (USMR) & CIC 14-01 EC, Bordeaux, France
| | - Sabrina Lacomme
- University of Bordeaux, UMS 3420 CNRS, US4 INSERM, Bordeaux Imaging Center, Bordeaux, France
| | - Etienne Gontier
- University of Bordeaux, UMS 3420 CNRS, US4 INSERM, Bordeaux Imaging Center, Bordeaux, France
| | - Marlène Durand
- CHU Bordeaux, CIC 14-01 IT, Bordeaux, France.,University of Bordeaux, Bordeaux, France.,INSERM, Tissue Bioengineering, U1026, Bordeaux, France
| | | | - Antoine Bénard
- CHU Bordeaux, Public Health Unit, Clinical Epidemiology Unit (USMR) & CIC 14-01 EC, Bordeaux, France
| | - Laurence Bordenave
- CHU Bordeaux, CIC 14-01 IT, Bordeaux, France.,University of Bordeaux, Bordeaux, France.,INSERM, Tissue Bioengineering, U1026, Bordeaux, France
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