Long-term Use and Follow-up of Irradiated Homologous Costal Cartilage
                        Grafts in the Nose

Kridel, Russell W. H.; Ashoori, Faramarz; Liu, Edmund S.; Hart, Carol G.

doi:10.1001/archfaci.2009.91

Cited by 54 publications

(4 citation statements)

References 39 publications

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“…There have been many previous publications examining the rates of complications including infection, resorption, and warping for both CCA and HCA. 1,2,4,5 However, published rates vary widely and there remains no consensus as to which is the more reliable graft option. Variability in complication rates has been attributed to reporting and publication bias, inconsistent definitions, low level of evidence, and surgeon technique.…”

Section: Discussionmentioning

confidence: 99%

“…22 Rates of revision after HCA grafting are cited between 3% and 8%. 4,6,23 Given the heterogeneity of the published literature, the upper limit related to revision rate of 8% was chosen for this subgroup to avoid underestimating the cost and falsely elevating the value. Rates of costal cartilage use at revision procedure (7%), 24 pneumothorax (0.01%), 25 and admission after rhinoplasty (1%) 26 were used based on published outcomes.…”

Section: Methodsmentioning

confidence: 99%

“…In addition, there is additional time required in the operating room for the harvesting of costal cartilage. 4,5 HCA both avoids the potential complications of harvesting costal cartilage from the patient. However, it has been associated with an unpredictable rate of resorption, infection, and warping with widely varying rates of cited overall complications ranging from 3% to nearly 30%.…”

Section: Introductionmentioning

confidence: 99%

“…However, it has been associated with an unpredictable rate of resorption, infection, and warping with widely varying rates of cited overall complications ranging from 3% to nearly 30%. 4,[6][7][8] As such, the clear superiority of 1 graft over the other has not yet been demonstrated.…”

Section: Introductionmentioning

confidence: 99%

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Cost Utility Analysis of Costal Cartilage Autografts and Human Cadaveric Allografts in Rhinoplasty

Starr

Creel

Harryman

et al. 2021

Ann Otol Rhinol Laryngol

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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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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Cost Utility Analysis of Costal Cartilage Autografts and Human Cadaveric Allografts in Rhinoplasty

Starr

Creel

Harryman

et al. 2021

Ann Otol Rhinol Laryngol

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The Evolution of the Archives of Facial Plastic Surgery

Larrabee¹

2009

Archives of Facial Plastic Surgery

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Bone and Cartilage Wedge Technique in Posttraumatic Enophthalmos Treatment

Lieger

Zix

Kruse

et al. 2010

Archives of Facial Plastic Surgery

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OBJECTIVE: To evaluate a new surgical method, using calvarial bone graft combined with a wedge of irradiated homologous costal cartilage, for the revision repair of posttraumatic enophthalmos. METHODS: This retrospective study was performed from January 1, 2003, through December 31, 2007. Eight patients were diagnosed as having unilateral posttraumatic enophthalmos. All the patients had previously undergone insufficient primary repair of their orbital fractures. In the revision surgery a calvarial bone graft was placed in the area of the defect using a transconjunctival approach. In combination with this technique, a wedge of irradiated rib cartilage was placed on the bone graft behind the globe. Patients were assessed preoperatively and postoperatively by ophthalmologists and maxillofacial surgeons. Standard follow-up examinations were performed at 2 and 4 weeks and at 3 and 6 months after surgery. Computed tomographic scans were obtained preoperatively and postoperatively from all patients. RESULTS: For all 8 corrected orbits, favorable cosmetic results were obtained regarding the position of the globe. The mean preoperative Hertel exophthalmometer showed a difference of 3.1 mm and 0.7 mm postoperatively. Improvement of ocular motility and reduction of diplopia were achieved in only 1 patient; in the others, motility and diplopia remained unchanged. No postoperative complications were observed. CONCLUSION: The bone and cartilage wedge technique seems to be a useful surgical technique for the cosmetic correction of posttraumatic enophthalmos.

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Long-term Use and Follow-up of Irradiated Homologous Costal Cartilage Grafts in the Nose

Cited by 54 publications

References 39 publications

Cost Utility Analysis of Costal Cartilage Autografts and Human Cadaveric Allografts in Rhinoplasty

Cost Utility Analysis of Costal Cartilage Autografts and Human Cadaveric Allografts in Rhinoplasty

The Evolution of the Archives of Facial Plastic Surgery

Bone and Cartilage Wedge Technique in Posttraumatic Enophthalmos Treatment

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