Reconstructive Rhinoplasty Using Multiplanar Carved Costal Cartilage

Nuara, Michael J.; Loch, Randall; Saxon, Sarah

doi:10.1001/jamafacial.2015.2251

Cited by 18 publications

(4 citation statements)

References 10 publications

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“…These studies comprised 1041 patients of whom 741 received autologous grafts and 293 received IHCC grafts. Studies were published between January 1, 1990, and December 31, 2017; the mean sample size was 36 patients (range, 9-157 patients); and studies were from countries around the world, including Turkey (n = 9), 3,[23][24][25][26][27][28][29][30] the United States (n = 5), 9,13,[31][32][33] South Korea (n = 4), 14,18,19,34 Italy (n = 2), 35,36 India (n = 2), 37,38 the United Kingdom (n = 1), 39 Germany (n = 1), 40 the Netherlands (n = 1), 15 Egypt (n = 1), 41 South Africa (n = 1), 42 and Saudi Arabia (n = 1). 43 Mean follow-up time ranged from 6 to 48 months in the studies that reported follow-up, although 8 studies did not.…”

Section: Resultsmentioning

confidence: 99%

Comparison of Autologous vs Homologous Costal Cartilage Grafts in Dorsal Augmentation Rhinoplasty

Vila

Jeanpierre

Rizzi

et al. 2020

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Augmentation rhinoplasty requires adding cartilage to provide enhanced support to the structure of the nose. Autologous costal cartilage and irradiated homologous costal cartilage (IHCC) are well-accepted rhinoplasty options. Tutoplast is another alternative cartilage source. No studies, to our knowledge, have definitively demonstrated a higher rate of complications with IHCC grafts compared with autologous costal cartilage grafts. OBJECTIVE To compare rates of outcomes in the published literature for patients undergoing septorhinoplasty with autologous costal cartilage vs IHCC grafts vs Tutoplast grafts.DATA SOURCES For this systematic review and meta-analysis, the MEDLINE, Embase, Scopus, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched for articles published from database inception to February 2019 using the following keywords: septorhinoplasty, rhinoplasty, autologous costal cartilage graft, cadaveric cartilage graft, and rib graft.STUDY SELECTION Abstracts and full texts were reviewed in duplicate, and disagreements were resolved by consensus. Only patients who underwent an en bloc dorsal onlay graft were included for comparison to ensure a homogenous study sample. A total of 1308 results were found. After duplicate records were removed, 576 unique citations remained. Studies were published worldwide between January 1, 1990, and December 31, 2017.DATA EXTRACTION AND SYNTHESIS Independent extraction by 2 authors was performed. Data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURESAll reported outcomes after septorhinoplasty and rates of graft warping, resorption, infection, contour irregularity, and revision surgery among patients receiving autologous grafts vs IHCC vs Tutoplast cartilage grafts. RESULTSOf 576 unique citations, 54 studies were included in our systematic review; 28 studies were included after applying inclusion and exclusion criteria. Our search captured 1041 patients of whom 741 received autologous grafts and 293 received IHCC grafts (regardless of type). When autologous cartilage (n = 748) vs IHCC (n = 153) vs Tutoplast cartilage (n = 140) grafts were compared, no difference in warping (5%; 95% CI, 3%-9%), resorption (2%; 95% CI, 0%-2%), contour irregularity (1%; 95% CI, 0%-3%), infection (2%; 95% CI, 0%-4%), or revision surgery (5%; 95% CI, 2%-9%) was found. CONCLUSIONS AND RELEVANCENo difference was found in outcomes between autologous and homologous costal cartilage grafts, including rates of warping, resorption, infection, contour irregularity, or revisions, in patients undergoing dorsal augmentation rhinoplasty. En bloc dorsal onlay grafts are commonly used in augmentation rhinoplasty to provide contour and structure to the nasal dorsum.

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Section: Resultsmentioning

confidence: 99%

Comparison of Autologous vs Homologous Costal Cartilage Grafts in Dorsal Augmentation Rhinoplasty

Vila

Jeanpierre

Rizzi

et al. 2020

JAMA Otolaryngol Head Neck Surg

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“…Gibson and Davis first reported on the principle of the balanced section, cutting the cartilage in such a way that the intrinsic oppositional forces are in equilibrium, causing them to be neutralized. Since then, many other authors have tried to refine this principle to further reduce the amount of warp or the operative morbidity . Studies have also been performed to evaluate whether the level of rib, orientation of the balanced section, or storage conditions of the graft affect warpage: none had a significant effect.…”

Section: Introductionmentioning

confidence: 99%

A Comparison of Costal Cartilage Warping Using Oblique Split vs Concentric Carving Methods

Wilson

Dias

Faris

2017

JAMA Facial Plast Surg

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Warping of costal cartilage is well described; however, its strength and abundance still make it a desirable graft material, especially in complex reconstructive rhinoplasty. Despite multiple methods of cartilage harvest, carving, and preimplantation treatment being developed over the years, warp remains a challenging clinical problem. OBJECTIVE To assess whether the 30°oblique split method of preparing costal cartilage grafts produces less warping of the graft than the current standard of harvesting the central segment of a rib using the concentric carving method. DESIGN, SETTING, AND PARTICIPANTS This in vitro cadaveric study evaluated the warping of costal cartilage grafts using the oblique split method with an angle of 30°or the concentric carving method during a 3-month period beginning in December 2014. MAIN OUTCOMES AND MEASURES Millimeters of warp from baseline (at 1 hour) and at 1, 2, and 3 months, measured in the frontal and lateral planes. RESULTS Among 74 costal cartilage grafts (using the oblique split method with an angle of 30°in 41 and the concentric carving method in 33), the mean amount of warp in the frontal plane was between 1.12 mm (95% CI, 0.96-1.28 mm) and 1.57 mm (95% CI, 0.94-2.20 mm) for the oblique group and between 1.18 mm (95% CI, 0.98-1.38 mm) and 1.29 mm (95% CI, 0.86-1.72 mm) for the concentric group during the 3-month period. There was no statistically significant difference in the frontal plane between the 2 methods at 1 hour (P = .45; 0.10 mm, 95% CI, −0.38 to 0.17 mm), 1 month (P = .32; 0.13 mm, 95% CI, −0.13 to 0.40 mm), 2 months (P = .50; 0.28 mm, 95% CI, −0.55 to 1.11 mm), or 3 months (P = .15; 0.22 mm, 95% CI, −0.08 to 0.52 mm) using the t test, regression analysis, or panel data analysis. Similarly, no significant difference was found in the lateral plane at 1 hour (P = .89; 0.04 mm, 95% CI, −0.49 to 0.56 mm), 1 month (P = .82; 0.07 mm, 95% CI, −0.56 to 0.70 mm), 2 months (P = .29; 0.40 mm, 95% CI, −0.36 to 1.17 mm), or 3 months (P = .63; 0.22 mm, 95% CI, −0.70 to 1.13 mm) using the t test. Two grafts were excluded due to desiccation. CONCLUSIONS AND RELEVANCE The 30°oblique split and concentric carving methods of costal cartilage graft carving are equivalent in terms of the amount of warp. The oblique split method may be superior because of easier carving and the increased volume of material. LEVEL OF EVIDENCE NA.

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“…As regard rib cartilage, it has many drawbacks such as learning curve is needed, pneumothorax may occur, and asymmetry of chest wall can present [ 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

The Use of Mastoid Fascia for Dorsal Nasal Augmentation

El-Sabbagh

2017

Medicine and Pharmacy Reports

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Background and aimDorsal augmentation of the nose is needed after trauma, rhinoplasty or for ethnic reasons. Alloplastic or autogenous materials may be used. In this paper, postauricular mastoid fascia was used for dorsal nasal augmentation.MethodsThis study included ten patients who underwent dorsal nasal augmentation. Fascia over mastoid area was taken in all cases and was fixed with Steri-Strips and external nasal splints.ResultsAll patients were female except one case. Five patients had the operation because of ethnic causes and five patients did the operation due to post traumatic deformity. Donor sites healed uneventfully. Digital photography was taken to assess the grafts and follow up was extended up to 9 months.ConclusionsMastoid fascia is a reliable method and its donor site is hidden. In addition, it can be a potential site for conchal graft if needed.

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Reconstructive Rhinoplasty Using Multiplanar Carved Costal Cartilage

Cited by 18 publications

References 10 publications

Comparison of Autologous vs Homologous Costal Cartilage Grafts in Dorsal Augmentation Rhinoplasty

Comparison of Autologous vs Homologous Costal Cartilage Grafts in Dorsal Augmentation Rhinoplasty

A Comparison of Costal Cartilage Warping Using Oblique Split vs Concentric Carving Methods

The Use of Mastoid Fascia for Dorsal Nasal Augmentation

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