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Wells MW, McCleary SP, Chang IA, Deleonibus A, Kotha VS, Rampazzo A, Delong MR, Roostaeian J. A systematic review and meta-analysis of complications associated with crushed cartilage in rhinoplasty. J Plast Reconstr Aesthet Surg 2024; 96:231-241. [PMID: 39098291 DOI: 10.1016/j.bjps.2024.06.019] [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: 04/19/2024] [Accepted: 06/30/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Crushed cartilage grafts improve augmentation and contour irregularities in rhinoplasty; however, they are associated with complications including resorption, asymmetries, palpability, and need for revision surgery. METHODS A systematic review and meta-analysis following the preferred reporting items for systematic reviews and meta-analyses guidelines was performed on all recorded history up to November 2022 using the search query ("crush" or "crushed") AND cartilage AND rhinoplasty for PubMed, World of Science, Embase, and Cochrane online registries. Data were collected on study information, patient demographics, surgical details, and outcomes. Graft resorption and revision surgery were pooled in a random-effects model, and a subgroup analysis was performed for coverage/non-coverage of the cartilage and degree of crushing. RESULTS The initial search yielded 163 results, with 11 studies included in the final full-text review. A total of 1132 patients were analyzed, with 456 (40.3%) women, mean age of 48.0 years, and an average follow-up period of 24.9 months. Cartilage resorption rates were statistically higher in graft preparation using severely crushed cartilage (3.4%) compared to non-severely crushed cartilage (0.9%, p = 0.049). There was no significant difference in resorption rate for patients with covered cartilage graft (1.3%) compared to those with non-covered grafts (1.8%, p = 0.7). There were significantly more revision surgeries for severely crushed (17.9%) compared to non-severely crushed (3.5%, p = 0.003) cartilage grafts. CONCLUSIONS Severely crushed cartilage grafting provides smooth contour and less palpability compared to other degrees of crushing but demonstrates significantly higher rate of resorption.
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Affiliation(s)
- Michael W Wells
- Division of Plastic and Reconstructive Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, United States
| | - Sean P McCleary
- Division of Plastic and Reconstructive Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, United States
| | - Irene A Chang
- Division of Plastic and Reconstructive Surgery, UC Davis School of Medicine, Sacramento, CA, United States
| | - Anthony Deleonibus
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, United States
| | - Vikas S Kotha
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, United States
| | - Antonio Rampazzo
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, United States
| | - Michael R Delong
- Division of Plastic and Reconstructive Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, United States
| | - Jason Roostaeian
- Division of Plastic and Reconstructive Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, United States.
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Segreto F, Marianetti T, Iademarco A, Cimmino AA, Rossi C, Persichetti P. Mechanically fragmented cartilage grafts in rhinoplasty: An up-to-date systematic review. J Plast Reconstr Aesthet Surg 2024; 95:250-265. [PMID: 38941779 DOI: 10.1016/j.bjps.2024.05.036] [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: 01/09/2024] [Revised: 04/26/2024] [Accepted: 05/24/2024] [Indexed: 06/30/2024]
Abstract
INTRODUCTION Grafts play key roles in functional and aesthetic rhinoplasty. Autologous grafts are generally preferred for their biocompatibility and less visibility when used in a fragmented fashion. The aim of this study was to review mechanically fragmented cartilage grafts techniques described in the literature, outlining indications, outcomes, and complications. MATERIAL AND METHODS A systematic review of articles published from 1999 until December 2022 was conducted, using the following key words: "rhinoplasty," "cartilage," and "graft." Studies were selected according to the inclusion and exclusion criteria, and data were extracted and grouped for subgroup analysis. Rates of partial resorption, total resorption, surgical revision, and major and minor complications were statistically analyzed. RESULTS Thirty eligible studies were included. Three cartilage fragmentation methods were identified: diced, shaved, and crushed. Cartilage grafts were further divided into injectable and noninjectable grafts. Diced cartilage was the most commonly used. Dorsal irregularities were the main indication. Overall, 1.68% of patients experienced partial resorption, 0.27% experienced total resorption, and 1.46% needed revision. The partial resorption rate in the diced group was significantly lower than that in the shaved group. Injectable grafts showed a higher rate of partial resorption. The revision rate was higher with noninjectable grafts. CONCLUSION The partial resorption rate was lower in patients treated with diced cartilage. Injectable grafts are malleable and suitable for the correction of minimal irregularities, although they are affected by a higher rate of partial resorption. Wrapping materials may be used when significant augmentation is required.
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Affiliation(s)
- Francesco Segreto
- Department of Plastic, Reconstructive and Aesthetic Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Tito Marianetti
- Maxillo-Facial Department, Assunzione di Maria Santissima Clinic, Rome, Italy
| | - Antonio Iademarco
- Maxillo-Facial Department, Assunzione di Maria Santissima Clinic, Rome, Italy
| | - Andrea A Cimmino
- Department of Plastic, Reconstructive and Aesthetic Surgery, Università Campus Bio-Medico di Roma, Rome, Italy.
| | - Caterina Rossi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Paolo Persichetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
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Nocini R, Abdulraheem M, Galzignato PF, Manzini J, Bernardi P, Conti G, Sbarbati A, Chirumbolo S, Bertossi D. Histology and Long-term Clinical Outcome of Crushed Cartilage with Double-layer Gelatin Sponge Membrane for Dorsum Refinement in Primary Rhinoplasty. Facial Plast Surg 2023; 39:679-685. [PMID: 36791802 DOI: 10.1055/s-0042-1749408] [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: 02/17/2023] Open
Abstract
This article demonstrates the ability to use autologous crushed cartilage grafts in rhinoplasty with rapid recovery and optimal nasal functionality without any tissue damage and allows its rapid rejuvenation. Eligible patients underwent primary rhinoplasty using autologous crushed cartilage graft followed by microscopy imaging of the grafted tissue after recovery. Tissue and cytological analysis using optical microscopy, transmission electronic microscopy (TEM), and scanning electronic microscopy (SEM) showed complete viability of chondrocytes, formation of new collagen fibers, neo-perichondrium, neo-angiogenesis, and exhibiting optimal aesthetic outcome. The surgical approach is easy to perform, feasible, and less time-consuming, with excellent tissue rejuvenation and rapid recovery.
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Affiliation(s)
- Riccardo Nocini
- Unit of Oral and Maxillofacial Surgery, Department of Surgery, Dentistry, Paediarics and Gynaecology, University of Verona, Verona, Italy
| | - Maryam Abdulraheem
- Department of Otolaryngology, Ambulatory Care Center (ACC), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Pier-Francesco Galzignato
- Unit of Oral and Maxillofacial Surgery, Department of Surgery, Dentistry, Paediarics and Gynaecology, University of Verona, Verona, Italy
| | - Jessica Manzini
- Azienda Ospedaliera Universitaria Integrata (AOUI) Policlinico GB Rossi, Verona, Italy
| | - Paolo Bernardi
- Unit of Human Anatomy, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giamaica Conti
- Unit of Human Anatomy, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Andrea Sbarbati
- Unit of Human Anatomy, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Salvatore Chirumbolo
- Unit of Human Anatomy, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Dario Bertossi
- Unit of Otorhinolaryngology, Department of Surgery, Dentistry, Paediarics and Gynaecology, University of Verona, Verona, Italy
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Gallo L, Kim P, Yuan M, Gallo M, Thoma A, Voineskos SH, Cano SJ, Pusic AL, Klassen AF. Best Practices for FACE-Q Aesthetics Research: A Systematic Review of Study Methodology. Aesthet Surg J 2023; 43:NP674-NP686. [PMID: 37162009 DOI: 10.1093/asj/sjad141] [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: 04/13/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND The FACE-Q Aesthetics module is a validated patient-reported outcome measure (PROM) that evaluates perspectives on facial aesthetic treatments. Improper administration and poor study methodology can compromise the validity and interpretation of this PROM. OBJECTIVES This systematic review sought to evaluate the administration and scoring of the FACE-Q Aesthetics scales within the literature. METHODS A search of Ovid Medline, Embase, Cochrane, and Web of Science was performed on December 20, 2022, with the assistance of a health-research librarian (CRD42022383676). Studies that examined facial aesthetic interventions using the FACE-Q Aesthetics module as a primary or secondary outcome measure were included for analysis. RESULTS There were 114 studies included. The Face Overall (n = 52, 45.6%), Psychological (n = 45, 39.4%), and Social (n = 43, 37.7%) scales were most frequently reported. Errors in FACE-Q administration were identified in 30 (26.3%) studies. The most common error was the presentation of raw ordinal scores rather than the converted Q score (n = 23). Most studies reported a time horizon for their primary analysis (n = 76, 66.7%); however, only 4 studies provided a rationale for this selection. Sample size calculations for the primary outcome were rarely performed (n = 9, 7.9%). CONCLUSIONS There continues to be limitations in PROM administration and the quality of articles that report FACE-Q Aesthetic scale data. The authors suggest that future investigators using the FACE-Q refer to the User's Guide regarding administration and scoring of this scale, report a rationale for the study time horizon, and provide an a priori sample size calculation for the primary outcome of interest.
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Saadoun R, Solari MG, Rubin JP. The Role of Autologous Fat Grafting in Rhinoplasty. Facial Plast Surg 2023; 39:185-189. [PMID: 36100254 DOI: 10.1055/a-1942-2225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Rhinoplasty is one of the most popular aesthetic surgeries worldwide and often includes grafting techniques to achieve optimal results. One of these grafting techniques is autologous fat transfer, which has been used to increase volume, camouflage irregularities, and/or improve the quality of the nasal skin-soft tissue envelope. Moreover, minimally invasive approaches for altering the nasal appearance have recently increased and become known as "liquid" or "nonsurgical rhinoplasty." These nonsurgical approaches include altering the nasal appearance with filler injection to induce volumetric changes in lieu of extensive surgery. The use of fat grafting as a filler is favorable to achieve well-balanced aesthetic results without compromising the nasal skin-soft tissue envelope. This capability is partly because of the regenerative potential of fat grafts, serving to improve the quality of surrounding soft tissues. In contrast, commercial injectable fillers are inert. This article highlights the role of fat grafting in surgical and nonsurgical rhinoplasty to provide surgeons with an overview of the potential of these vastly abundant, biocompatible, and cost-effective grafts.
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Affiliation(s)
- Rakan Saadoun
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
- Medical Faculty Mannheim, Ruprecht Karl University of Heidelberg, Mannheim, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Centre Mannheim, Mannheim, Germany
| | - Mario G Solari
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - J Peter Rubin
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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Cotofana S, Gotkin RH. Invited Discussion on: Crushed Cartilage and Autologous Fat for Dorsal Nasal Refinement. Aesthetic Plast Surg 2021; 45:2278-2279. [PMID: 34002245 DOI: 10.1007/s00266-021-02347-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
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