Surgical Nasal Implants: Indications and Risks

Abstract

Rhinoplasty often requires the use of grafting material, and the goal of the specific graft dictates the ideal characteristics of the material to be used. An ideal material would be biologically inert, resistant to infection, noncarcinogenic, nondegradable, widely available, cost-effective, readily modifiable, and easily removable, have compatible biomechanical characteristics, retain physical properties over time, and not migrate. Unfortunately, no material currently in existence meets all of these criteria. In modern rhinoplasty, autologous grafts are the gold standard against which all other nasal implants are measured and offer the safest long-term results for most patients. They are easily manipulated, have inherent stability and biomechanical characteristics similar to the native nasal framework, and confer minimal risk of complications. Modern homologous and alloplastic materials have gained considerable support in recent years because they are readily available in endless quantity, do not require a second surgical site for harvest, and are generally considered safe if most circumstances, but they confer additional risk and have biomechanical characteristics different from that of the native nasal framework. To address some of these issues, we provide a contemporary review of autologous, homologous, and alloplastic materials commonly used in rhinoplasty surgery.

The hydroxyapatite Turkish Delight: a technical note

“…A minimal inflammatory response is induced by autologous cartilage, with low graft infection, resorption, and extrusion rates. Irradiated homologous cartilage grafts induce resorption in 1–7.4% of cases, displacement in 0.3–5.9% of cases, and warping in 1–14.8% of cases [1]. The use of silicone and polyethylene results in significant rates of infection (up to 4%), displacement, extrusion (up to 10%), and exposure due to chronic inflammation with encapsulation and lack of biointegration [1].…”

“…The nasal cartilaginous septum is the most frequently used graft material for limited augmentation, mainly because it obviates the need for an extra donor site [1]. This material can be reshaped, carved, diced, or crushed to match the defect.…”

“…However, its availability is limited, particularly in revision rhinoplasty if the septal cartilage has been harvested previously. Drawbacks in the use of autologous grafts from a distant site, especially rib grafts, include prolonged surgical time and complexity, donor-site morbidity, difficult graft shaping, graft displacement (1–12.5%) [1], and an unpredictable rate of resorption (0.5–5%) [3, 4]. With solid cartilage grafts, the bone-cartilage transition can be viewed through the nasal skin after the resolution of edema [3, 4].…”

“…Augmentation of the nasal dorsum has been achieved using various techniques and materials [1–3]. Autologous cartilage is most commonly used as a graft material and remains the gold standard against which other materials are compared [1].…”

“…Autologous cartilage is most commonly used as a graft material and remains the gold standard against which other materials are compared [1]. In 2000, Erol was the first to describe the use of diced cartilage that was wrapped in a monolayer of oxidized cellulose (Surgicel®, Ethicon, Somerville, USA), termed the Turkish Delight technique [2–4].…”