Complications Associated with Autologous Costal Cartilage Used in Rhinoplasty: An Updated Meta-Analysis

The Lateral Wall of the Inferior Meatus as a New Graft Source for Rhinoplasty: Radiological Study and Surgical Technique

Generally, revision rhinoplasty cases require the use of stiff grafts to restore the lost support. However, the majority of patients indicated for revision surgery present with a lack of a bony cartilaginous framework of the septum, especially after previous septoplasty. Thus, surgeons are compelled to harvest costal cartilage. At the same time, rib graft harvesting is associated with additional trauma and a risk of serious complications. Being ENT surgeons, we often resect a part of the lateral wall of the inferior nasal meatus during the extended endoscopic approach to the maxillary sinus. We supposed that this bone plate could be used as a donor site for rhinoplasty graft harvesting. The aim of our study was a radiological assessment of the feasibility and limits of using the inferior meatus lateral wall (IMLW) as a donor site for rhinoplasty bone graft.A retrospective evaluation of 100 CT scans of sinuses was conducted. Further measurements of the IMLW were performed: average length and width (28.06 ± 4.03 mm and 19.73 ± 3.08 mm, respectively), thickness (0.62 ± 0.21 mm), and average deviation from the sagittal plane (17.7 ± 9.53 degrees). According to the obtained measurements, the described donor site is appropriate for harvesting nice straight bony fragments.The IMLW bone graft was used in four revision rhinoplasty cases. There were no postoperative complications. During the long-term follow-up, patients reported significant improvement in aesthetics, function, and social aspects according to Rhinoplasty Outcome Evaluation. Thus, the described technique is an easy and safe method for bone harvesting for revision rhinoplasty. Our first experience demonstrated the convenience and stability of IMLW grafts for revision rhinoplasty during the follow-up period of up to 2 years.

Effect of Medical Ozone Therapy in Preventing Compromised Nasal Skin in Revision Rhinoplasty

BACKGROUND

Ozone is often used as an additive therapy for skin conditions like infectious diseases, wound healing, diabetic foot, and pressure ulcers. The viability of the nasal skin has crucial importance in revision rhinoplasty cases. The study investigates the potential benefits of medical ozone therapy in healing the nasal skin in multiple-operated cases.

METHODS

The study retrospectively examined 523 revision rhinoplasty patients operated by the first author from January 2017 to January 2024. Patients consenting to ozone therapy received 3 major autohemotherapy sessions post-surgery. Patients were divided into 2 groups: those with compromised nasal skin (infection, poor vascular supply) and those with normal healing. Age, gender, smoking, diabetes, previous surgeries, grafting materials, and techniques were considered.

RESULTS

Of the 523 patients, 12 (2.3%) experienced major skin complications like infection and necrosis, while 511 (97.7%) had no or minor issues, such as discoloration. In total, 301 patients accepted and received ozone therapy. Of the patients without major complications, 299 (58.3%) received ozone therapy, while 212 (41.7%) did not. Among the 12 with major complications, two (16.7%) received ozone therapy, and the remaining 10 (83.3%) did not. Ozone therapy recipients showed statistically fewer skin problems (p<0.05). Costal cartilage as tip and septal extension graft was linked to skin issues (p<0.05). No major adverse effects from ozone therapy were noted.

CONCLUSIONS

Our findings indicate that ozone therapy may be a safe and potentially effective option for patients undergoing revision rhinoplasty, especially those with compromised nasal skin. It appears to aid in skin healing and regeneration, possibly through enhancing oxygen delivery and modulation of the immune response. Ozone therapy is a promising adjunct treatment for managing skin complications in revision rhinoplasty patients.

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 .

Lollipop-Like Costal Cartilage Graft with a Peach-Shaped Head for East Asian Rhinoplasty

BACKGROUND

Nasal tip refinement is a challenging step of East Asian rhinoplasty due to complex anatomical defects. Autologous costal cartilage grafts are commonly used to provide nasal tip support. This study aims to evaluate the efficacy and safety of a modified technique using a lollipop-like cartilage graft with a peach-shaped head.

METHODS

A retrospective review was conducted on Chinese patients who underwent primary rhinoplasty with the modified technique between November 2018 and March 2021 at our center. Preoperative and postoperative facial photographs, patient-reported outcome measures including the visual analog scale (VAS) and the rhinoplasty outcome evaluation (ROE), as well as surgery-related complications, were collected for outcome assessment.

RESULTS

A total of 31 adult patients were included in this retrospective cohort study, with a mean follow-up period of 17.12 ± 3.89 months. The majority of patients (28/31; 90.3%) expressed satisfaction with the aesthetic outcomes, as evidenced by a significant increase in mean VAS score from 3.97 ± 1.52 preoperatively to 7.39 ± 0.22 postoperatively (P < 0.01), and a significant increase in mean ROE score from 11.77 ± 2.33 to 17.22 ± 2.47 (P < 0.01). Photogrammetric analysis also demonstrated significant improvements in nasal anatomical measurements. Among the three patients with unsatisfactory feedback, two had mild columella deviations and one had a mild dorsum deviation. No other notable complications were reported.

CONCLUSION

The current study supports the safety and utility of the modified technique utilizing the lollipop-like costal cartilage graft with a peach-shaped head for major tip refinement in East Asian patients.

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 .

Complications of Nasal Tip Stabilizing Grafts with Autologous Versus Irradiated Homologous Costal Cartilage in Septorhinoplasty: A Systematic Review

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.

A Retrospective Study on the Reconstruction of Nasal Septal Mucosal Defects after Asian Rhinoplasty

BACKGROUND

Nasal septal mucosal defects following rhinoplasty in Asian patients are uncommon complications. However, the reconstruction of such defects presents a challenging task in plastic surgery. The aim of this study was to present comprehensive surgical strategies for the reconstruction of nasal septal mucosal defect after rhinoplasty.

METHODS

Thirteen cases presenting with nasal septal mucosal defects between January 2016 and October 2021 were retrospectively reviewed. The size, location, and severity of the defect as well as the extent of cartilage exposure were taken into consideration during evaluation, and surgical approaches were employed for repair accordingly. Patient satisfaction was evaluated using a questionnaire with visual analog scale (VAS) and nasal obstruction symptom evaluation scale (NOSE).

RESULTS

The average postoperative follow-up period in this study group was 10.15 months. Reconstruction of nasal septal mucosal defects resulted in successful treatment for all patients. There was no evidence of flap failure or nasal valve stenosis. All patients were satisfied with the reconstruction outcome.

CONCLUSIONS

The successful application of surgical techniques for nasal septal mucosal defects after rhinoplasty requires comprehensive consideration. The utilization of the retrograde-flow superior labial artery mucosal flap appears to be a secure, efficient, and effective technique for nasal septal mucosal defect reconstruction in rhinoplasty, particularly in cases with cartilage exposure.

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 .

1064nm Nd:YAG laser promotes chondrocytes regeneration and cartilage reshaping by upregulating local estrogen levels

Cartilage is frequently used as a scaffolds for repairing and reconstructing body surface organs. However, after successful plastic surgery, transplanted cartilage scaffolds often exhibit deformation and absorption over time. To enhance the shaping stability of cartilage scaffolds and improve patients' satisfaction after reconstructions, we employed the ear folding models in New Zealand rabbits to confirm whether the 1064nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser could promote cartilage reshaping. There was an increase in collagen and aromatase (Cyp19) expression within the ear cartilage after laser treatment. Moreover, we have found that the Cyp19 inhibitor can inhibit the laser's effect on cartilage shaping and reduce collagen and Cyp19 expression. The overall findings suggest that treatment with 1064nm Nd:YAG laser irradiation can enhance estrogen levels in local cartilage tissues by upregulating Cyp19 expression in chondrocytes through photobiomodulation, thereby promoting the proliferation and collagen secretion of chondrocytes to improve cartilage reshaping and stability.

Use of human acellular dermal matrix in rhinoplasty: a systematic review of the literature and meta-analysis

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.

Nuclear Factor-κB Decoy Oligodeoxynucleotide Attenuates Cartilage Resorption In Vitro

BACKGROUND

Cartilage harvest and transplantation is a common surgery using costal, auricular, and septal cartilage for craniofacial reconstruction. However, absorption and warping of the cartilage grafts can occur due to inflammatory factors associated with wound healing. Transcription factor nuclear factor-κB (NF-κB) is activated by the various stimulation such as interleukin-1 (IL-1), and plays a central role in the transactivation of this inflammatory cytokine gene. Inhibition of NF-κB may have anti-inflammatory effects. The aim of this study was to explore the potential of an NF-κB decoy oligodeoxynucleotide (Decoy) as a chondroprotective agent.

MATERIALS AND METHODS

Safe and efficacious concentrations of Decoy were assessed using rabbit nasal septal chondrocytes (rNSChs) and assays for cytotoxicity, proteoglycan (PG) synthesis, and PG turnover were carried out. The efficacious concentration of Decoy determined from the rNSChs was then applied to human nasal septal cartilage (hNSC) in vitro and analyzed for PG turnover, the levels of inflammatory markers, and catabolic enzymes in explant-conditioned culture medium.

RESULTS

Over the range of Decoy conditions and concentrations, no inhibition of PG synthesis or cytotoxicity was observed. Decoy at 10 μM effectively inhibited PG degradation in the hNSC explant, prolonging PG half-life by 63% and decreasing matrix metalloprotease 3 (MMP-3) by 70.7% (p = 0.027).

CONCLUSIONS

Decoy may be considered a novel chondroprotective therapeutic agent in cartilage transplantation due to its ability to inhibit cartilage degradation due to inflammation cytokines.

Minimally Invasive Harvesting Technique for Costal Cartilage Graft: Donor Site, Morbidity and Aesthetic Outcomes

Cartilage grafts are well-known as being reliable in reconstructive surgery for craniofacial pathologies. The aim of this study is to describe a new technique which requires an incision smaller than 1.5 cm but is still effective for harvesting cartilage graft. Thirty-six patients who underwent costal cartilage harvesting for septorhinoplasty have been included in this study, admitted from January 2018 to December 2021. Out of 36 patients, 34 have not reported any major complications, and two cases were followed up for pneumothorax. There were no infections and no chest wall deformities. All patients reported minimal pain at the donor site. The Vancouver Scar Scale was used to evaluate the entity of the postoperative scarring phenomena. This scale total ranges from 0 (representing normal skin) to a maximum score of 13 (representing worst scar imaginable). The results were 1.53 SD ± 0.64 (on average) 1 week after the surgical procedure and 1.28 SD ± 0.45 (on average) at the 6 months follow-up. This minimally invasive method provided a valid and effective surgical technique for cartilage graft. Despite the limitations of the case series, it seems that this procedure might be comparable to other and well-established traditional procedures and could be even preferred when the minimal invasiveness is mandatory.