Comparison of Patient Satisfaction Between Composite and Dorsum Augmentation-Only Nasal Reconstructions With Diced Cartilage Graft Wrapped in Fascia

Comparison of the efficacy of fat, cartilage, and bone grafts in traumatic and asymmetric noses

BACKGROUND

Correction of asymmetry and irregularity deformities with autologous grafts, without osteotomies, offers advantages to both plastic surgeons and patients with severe deviation. Various autologous tissues such as fat, bone, and cartilage grafts are viable options for this purpose.

OBJECTIVES

This study aimed to compare the efficacy of 3 autologous filling materials in patients with bone asymmetry.

METHODS

A retrospective evaluation was conducted on 297 patients seeking aesthetic nose surgery between 2015 and 2022. Only primary patients without prior surgery and those with bone asymmetry from trauma, with dorsum protrusion <3 mm, and without osteotomy were included. Patients were divided into fat, cartilage, and bone groups. Grafts were applied to the concave side during closed rhinoplasty, and evaluations were done 12 months after surgery by blinded plastic surgeons and patients using established assessment tools.

RESULTS

Fat, cartilage, and bone grafts were utilized in 74, 127, and 96 patients, respectively, with a mean follow-up of 19 months. The mean graft volumes were 1.0 cc (bone), 1.3 cc (cartilage), and 1.6 cc (fat). The patient self-assessment scores were 75%, 84.9%, and 86.6%, respectively. The Asher-McDade averages were 77.2%, 86.7%, and 88.4%, respectively. Cartilage and bone graft results were statistically similar in patients' self-evaluation and significantly higher than those of fat grafts. Blinded assessments showed no significant difference between the cartilage and bone groups.

CONCLUSION

Placing autologous grafts on the concave side for patients with minimal nasal bone protrusion (<3 mm) yields successful results. Cartilage grafts offer advantages in volume, result estimation, and preparation time, making them suitable for larger patient cohorts.

Mechanically fragmented cartilage grafts in rhinoplasty: An up-to-date systematic review

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.

A Systematic Review and Meta-Analysis of Complications Associated With Autogenous Diced Cartilage Wrapped in Fascia Used in Nasal Dorsum Augmentation

BACKGROUND

Nasal dorsum augmentation is a highly challenging rhinoplastic procedure. Problems encountered in this surgery, such as residual humps, irregularities, and asymmetry, account for a significant number of revision rhinoplasties.

OBJECTIVES

The aim of this meta-analysis was to assess complication rates and graft harvesting site morbidity and revision rates.

METHODS

We carried out a systematic review of the literature for pertinent materials in PubMed/Medline and Google Scholar up to and including August 2020. In addition, the reference list of included studies was searched manually. The criteria used were those described in the PRISMA Declaration for performing systematic reviews.

RESULTS

The initial search yielded 236 results. After 3 stages of screening, 16 papers (18 groups) were included in the systematic review and meta-analysis. Our results indicated that the total rates for the complications studied were as follows: graft resorption, 2.52%; insufficient augmentation, 3.93%; deviation (graft displacement), 1.77%; infection, 2.30%; irregularity, 1.36%; supra-tip depression, 1.13%; overcorrection, 3.06%; hematoma at recipient site, 1.36%; and visible bulging of the graft, 2.64%. The total rates for donor site hypertrophic scar and donor site hematoma were 2.64% and 3.58%, respectively. The rate of the revision surgery was 3.03%.

CONCLUSIONS

Current findings suggest the overall complications and revision rates with the use of diced cartilage wrapped in fascia for dorsum augmentation were relatively low and this technique is a reliable treatment choice for patients with primary/secondary dorsum deficiencies. Further studies with larger sample sizes and long-term follow-ups, clearer definitions of complications, and objective measurements are warranted to draw reliable practical conclusions.

LEVEL OF EVIDENCE: 4

Patient Satisfaction following Structural versus Preservation Rhinoplasty: A Systematic Review

Recently, dorsal preservation rhinoplasty has been gained acceptance among facial plastic surgeons. Despite this, there is limited literature on patient satisfaction following preservation rhinoplasty. This systematic review aims to evaluate all studies quantifying patient satisfaction and to compare results between structural and dorsal preservation rhinoplasty. OVID Medline, EMBASE, and PubMed databases were searched. All studies from the years 2010 to 2020 evaluating satisfaction in patients receiving either structural or dorsal preservation rhinoplasty were included. Data regarding study demographics as well as patient satisfaction results were extracted from included studies. Descriptive results and analysis were calculated. A total of 2,172 articles were initially identified, of which 29 articles were included in the final analysis. Of the 29 articles, 25 were focused on structural rhinoplasty and 4 were focused on preservation rhinoplasty. Of the 25 structural rhinoplasty articles, 17 used the Rhinoplasty Outcome Evaluation (ROE) questionnaire to evaluate patient satisfaction and 5 used the FACE-Q scale. Among the 25 structural rhinoplasty studies, 14 (56%) reported statistically significant improvements in patient satisfaction evaluation scores after rhinoplasty. Among the four preservation rhinoplasty studies, one (25%) study reported significant improvements in satisfaction scores after rhinoplasty. Despite this, most studies included a statement that satisfaction improved in patients following rhinoplasty. Literature in this review supports both structural and preservation rhinoplasty, resulting in high satisfactory results for patients following surgery. More research must be conducted to further quantify satisfaction following preservation rhinoplasty and prospectively compare satisfaction between the two rhinoplasty techniques.