The Use of Allogeneic Cartilage for Grafting in Functional and Reconstructive Rhinoplasty

Read-Fuller, Andrew; Yates, David M.; Radwan, Alaaaldin M.; Finn, Richard A.

doi:10.1016/j.joms.2018.03.021

Cited by 20 publications

(10 citation statements)

References 33 publications

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“…Infection can occur due to lax intraoperative asepsis, improper postoperative wound care, and local skin breakdown leading to infection. 24,25 Rejection of the artificial prosthesis is also a risk factor for infection. Some surgeons have argued that as long as the implant is their own tissue, even if there is an infection, there is no need to remove it and the infection can be controlled by changing the dressing and using antibiotics.…”

Section: Discussionmentioning

confidence: 99%

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Complications and Treatments of Pseudomonas aeruginosa Infection After Rhinoplasty With Implants: A Clinical Study

Zeng

Tang

et al. 2022

Journal of Craniofacial Surgery

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Background: Pseudomonas aeruginosa is an opportunistic pathogen, and because of its specificity, its treatments appear tricky in postrhinoplasty infections with internal implants. This study summarizes the clinical characteristics and treatment of this type of infections to provide some reference for clinical work. Methods: We retrospectively analyzed 10 patients who were diagnosed with a nasal infection of P. aeruginosa after implant nasal augmentation. The results of the bacterial culture and drug sensitivity test of the patients’ wound secretions were summarized and analyzed. We summarized the characteristics of the patients’ infection and the treatments, and we also summarized the patients’ prognosis. Results: In these 10 cases, their implants included rib cartilage and ear cartilage alone, as well as their own cartilage combined with expanded polytetrafluoroethylene and silicone. All patients developed wound infections within 1 month after rhinoplasty, with bacterial cultures of P. aeruginosa. Prolonged use of sensitive antibiotics, as well as wound dressing changes, failed to keep the infection well under control. Patients whose implant was removed and thoroughly debrided within 1 week of infection did not experience any serious complications. In patients who were infected for >1 week before surgery to remove the implants, complications such as nasal column necrosis and nasal contracture occurred, and later the nasal repair was performed after multiple surgeries. Conclusions: For bacterial infections in postrhinoplasty wounds with implants, we recommend early bacterial culture. If the infection is clearly P. aeruginosa, the implant should be removed and thoroughly debrided as soon as possible to avoid serious complications. Level of Evidence: Level IV.

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Section: Discussionmentioning

confidence: 99%

“…The incidence of infection in rhinoplasty with artificial grafts is usually higher than that of self-cartilage grafts. Infection can occur due to lax intraoperative asepsis, improper postoperative wound care, and local skin breakdown leading to infection 24,25. Rejection of the artificial prosthesis is also a risk factor for infection.…”

Section: Discussionmentioning

confidence: 99%

Complications and Treatments of Pseudomonas aeruginosa Infection After Rhinoplasty With Implants: A Clinical Study

Zeng

Tang

et al. 2022

Journal of Craniofacial Surgery

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“…Although NVI is broadly understood to be a chronic and multifactorial problem, it is most often a manifestation of incompetent upper and lower lateral cartilages. Throughout the literature there are several techniques described for treating NVI, 16-18 both with surgery and more non-invasive procedures, but BNI offers the comfort of both minimal invasiveness and the possibility of a reversible intervention.…”

Section: Discussionmentioning

confidence: 99%

Combining Aesthetic Septorhinoplasty With Bioabsorbable Implants for Nasal Valve Insufficiency

et al. 2021

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This case report demonstrates the usage of a bioabsorbable nasal implant (BNI) in conjunction with an aesthetic septorhinoplasty. The authors uniquely chose to use this allograft due to inadequate autologous tissue secondary to previously performed temporomandibular joint arthroplasties. In addition to evaluating our case of a 22-year-old woman who received a BNI with an aesthetic septorhinoplasty, the authors performed a comprehensive literature review on the topic. Spanning 3 databases (Scopus, PubMed, and Cochrane), this review revealed 4 primary studies, totaling 349 patients. Each utilized nasal obstruction symptom evaluation (NOSE) scores to subjectively measure symptomatic improvement. We chose to use the NOSE questionnaire on our patient both preoperatively and postoperatively, in order to help demonstrate subjective improvement. The patient’s functional and aesthetic concerns were addressed in the operating room at Parkland Memorial Hospital under general anesthesia. Notably, the patient had previously had conchal cartilage harvested bilaterally, had insufficient septal cartilage for adequate grafting, and did not desire to undergo costal cartilage harvest. Therefore, all parties agreed to use a BNI to complete the functional component of the patient’s septorhinoplasty. This day-surgery first focused on the aesthetic septorhinoplasty followed by the placement of the BNI bilaterally. Following an uneventful postoperative course, our patient endorsed not only an aesthetic improvement but also an 88% functional improvement based on her NOSE score within 4 months of surgery. The authors were able to successfully integrate functional as well as aesthetic septorhinoplasty techniques under the constraints of having both limited autologous tissue and limited accepted options from the patient. For the patient and provider team, this newer allograft was confirmed to be effective and efficient. With the correct patient selection, this is an excellent adjunct procedure that can be quickly and safely performed either in conjunction with surgical rhinoplasty or as a standalone procedure by facial surgeons.

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“…Allogeneic rib cartilage is an option in patients who warrant the strength of rib cartilage yet wish to avoid donor site morbidity. 46 Shortcomings of rib cartilage grafts include calcification of cartilage that makes harvest and sculpting more challenging. Cartilage from younger patients has a propensity to warp, while older patients may be more calcified.…”

Section: Grafting Materials For the Definitive Cleft Lip Rhinoplastymentioning

confidence: 99%

Controversies in Cleft Rhinoplasty

2020

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Rhinoplasty for cleft lip nasal deformities challenges all cleft surgeons. There is great variability of phenotypical anatomy, but iatrogenic changes and scarring from the previous surgeries add another layer of complexity. Rhinoplasties on a patient with cleft lip–palate are technically and intellectually challenging to master requiring a patient-tailored approach. The shape and structure of the nose are changed to improve both function and aesthetic appearance. In the primary setting, nasoalveolar molding is a form of presurgical infant orthopaedics used for preparation before the cleft lip and nose repair. Intermediate stages should be conservative to minimize scarring, while the definitive cleft rhinoplasty utilizes cartilage grafts from septum, ear, or rib to sculpt the nose. Hereinto, we will outline the controversies, the evidence supporting certain techniques, and our preferences.

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The Use of Allogeneic Cartilage for Grafting in Functional and Reconstructive Rhinoplasty

Cited by 20 publications

References 33 publications

Complications and Treatments of Pseudomonas aeruginosa Infection After Rhinoplasty With Implants: A Clinical Study

Complications and Treatments of Pseudomonas aeruginosa Infection After Rhinoplasty With Implants: A Clinical Study

Combining Aesthetic Septorhinoplasty With Bioabsorbable Implants for Nasal Valve Insufficiency

Controversies in Cleft Rhinoplasty

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