The role of cartilage and bone allografts in nasal reconstruction

Abstract

Nasal reconstruction is challenging, considering surgical techniques complexity and difficulties in remodelling a tridimensional structure. Reconstructive requirements are: correct deformity evaluation, selecting the most suitable treatment option, respecting the principle of aesthetic subunit, appropriate reconstruction of each affected nasal layer, long-term stabile functional and aesthetic results. Reconstructive procedures range from simple to very complex. Conventional techniques can fail in restoring a satisfactory appearance in severely disfigured patients, for whom a new possibility arises: Vascularized Composite Allografts (VCA) transplantation. In this paper, we focus on nasal skeletal framework restoration. Structural defects may require a large amount of reconstructive material obtained usually from cartilage or bone autografts. Autologous cartilage is the gold standard in nasal architectural recovery, but in some cases, autologous graft sources are not available, imposing the necessity to use alternative solutions represented by the allografts or alloplastic materials. We analysed the specific features of skeletal allografts used in nasal reconstruction. With current clinical experience, the use of cartilage and bone allografts (especially irradiated cartilage homografts) shows a promising reconstructive option for nasal structural defects. For extensive facial defects, including midface deformities, impossible to restore with traditional surgical techniques, a new reconstructive era was open through the development of the VCA field.

Toward tissue-engineering of nasal cartilages

“…However, the immunogenicity of an allogeneic approach in the nose is unstudied. These grafts also have potential to transmit disease, to become infected, and to resorb [41,[69][70][71][72][73].…”

Cartilage Allografts for Aesthetic Nose Surgery: A Viable Option

“…Current findings suggest that composite tissue allotransplantation may be the elective option for reconstruction of the extensive defects with associated architectural and functional deficits in the midface region, impossible to approach by conventional surgical techniques. 2 …”

“…Although cartilage autograft remains the gold standard in structural reconstruction of the nose, for selected cases, allografts can be favored due to their large availability of resolving the continuous growing reconstructive demand and the necessity for a more simple surgical procedure in some patients. 2 Cartilage preservation was first described and possibly achieved by Prudden 3 in 1881.…”

Use of Grafts Materials in Dorsal Augmentation Rhinoplasty

“…Alternatively, allografts may be preferable and more acceptable to patients. [25][26][27] Allografts can be obtained from patients undergoing septoplasty or taken from donor banks. If taken from patients, patients are screened for viral infections before surgery, including hepatitis B, hepatitis C, and HIV.…”