Closed Rhinoplasty with a Mushroom-Shaped Costal Cartilage Graft in East Asian Patients

A Systematic Review and Meta-Analysis of Autologous vs Irradiated Homologous Costal Cartilage Grafts for Dorsal Augmentation Rhinoplasty

Autologous costal cartilage (ACC) is commonly used for dorsal augmentation rhinoplasty because of its availability and strength, despite risks such as hypertrophic scarring and pneumothorax for the patient. Irradiated homologous costal cartilage (IHCC) offers an alternative, potentially mitigating these complications. Previous reviews comparing these materials have been methodologically weak. The aim of this study is to perform a robust systematic review and meta-analysis comparing the outcomes of ACC and IHCC in dorsal augmentation rhinoplasty to guide clinical decision making in nasal reconstruction. Medline, Embase, Google Scholar, and the Cochrane Central Register of Controlled Trials databases were searched. Data extraction and quality assessment were performed by 2 independent authors. The primary outcomes of interest were warping, revision rates, infection rates, and displacement. Methodological quality and risk of bias were assessed using Grading of Recommendations Assessment, Development, and Evaluation and Cochrane's ROBINS I tool, respectively. Thirty-six articles were reviewed, including 1 comparative and 35 single-arm studies (ACC: 29, IHCC: 8), encompassing 2526 patients from 13 countries. Adverse events included warping (ACC: 6%, P < .0001; IHCC: 6%, P < .0001). Resorption rates were 1% for ACC (P = .06) and 3% for IHCC (P < .0001). Revision surgery rates were similar (ACC: 4%, P < .001; IHCC: 4%, P < .001), as were infection rates (ACC: 1.8%, P = .03; IHCC: 1.3%, P = .03). Current evidence does not demonstrate the superiority of ACC or IHCC for dorsal augmentation rhinoplasty. Both grafts are viable, with the choice guided by patient and surgeon preferences. Prospective, high-quality data with standardized outcomes are needed to improve clinical decision making.

Level of Evidence 2 Risk

The Application of a New Framework Construction Technique in Autologous Costal Cartilage Rhinoplasty

Background

In this study, the clinical efficacy of a new framework construction technique for costal cartilage rhinoplasty was investigated.

Methods

From January 2020 to February 2022, patients who underwent rhinoplasty in the department of plastic and reconstructive surgery of Zhejiang Provincial People's Hospital were enrolled. The sixth costal cartilage was made into the nasal columellar support graft (strut), the nasal tip graft integrated scaffold, and the septal extension grafts. The strut and septal extension grafts were sutured to construct the framework. Adobe Photoshop 6.0 was used to measure a series of aesthetic indices preoperatively and at 9 months postoperatively, including the nasal length, tip projection, nasofrontal angle, columellar/lobular angle, and nasolabial angle. The visual analog scale score and rhinoplasty outcome evaluation score were used to assess patient satisfaction. A paired t test was used for data analysis, and a P value of less than 0.05 was considered to indicate statistical significance.

Results

A total of 65 patients aged 19-43 years (average age 26.0 y) were enrolled. No short-term complications occurred. All patients were followed up for 9-23 months. There were statistically significant differences in all measurements (P < 0.05), which suggested that the aesthetic defects of the nose were corrected and that no obvious deflection or rotation of the nasal tip occurred. The visual analog scale score and rhinoplasty outcome evaluation score indicated a significant improvement in patient satisfaction (P < 0.05).

Conclusions

This new framework construction technique for costal cartilage rhinoplasty can reduce the risk of framework deflection and nasal tip rotation and provide a satisfactory nasal columellar shape.

A retrospective study on different kind of cartilage frameworks on Asian rhinoplasty

BACKGROUND

The character of Asian nose usually presents low projection of tip, short columellar, and short nose, necessitating the construction of a cartilage framework to achieve optimal results. The objective of this study was to evaluate the structural characteristics, stability, and postoperative outcomes of the integrated fixed framework, 1+1 framework, 2+1 framework, 4+1 framework, and Y-shaped framework.

METHODS

A retrospective analysis was conducted on a cohort of 612 patients who underwent rhinoplasty and were admitted between February 2017 and December 2022. According to rhinoplasty framework, the patients were categorized into fixed frameworks (integrated fixed framework group, 1+1 framework group, 2+1 framework group) or elastic frameworks(4+1 framework group, Y-shaped framework group). The stability of rhinoplasty frameworks was assessed by measuring nasal tip projection and nasolabial angle at both one and twelve months post-surgery. Postoperative follow-up included monitoring complications occurrence and evaluating patient satisfaction.

RESULTS

The mean duration of follow-up was 25.23 months (rang from 24 to 54 months). The overall satisfaction rate reached 89.37 %(547/612), with the highest satisfaction rate observed in 2+1 framework group.Compared with the integrated fixed, 1+1, 2+1 framework group, the nasolabial angle and nasal tip projection of 4+1, and Y-shaped framework group decreased more obviously(P < 0.001).

CONCLUSIONS

Nasal frameworks in Asians are generally classified as fixed frameworks or elastic frameworks. The stability of the fixed frameworks surpasses that of the elastic frameworks. The secure fixation of the strut to the anterior nasal spine can enhance the overall stability of the framework.

LEVEL OF EVIDENCE STATEMENT

IV.

Lollipop-Like Costal Cartilage Graft with a Peach-Shaped Head for East Asian Rhinoplasty

BACKGROUND

Nasal tip refinement is a challenging step of East Asian rhinoplasty due to complex anatomical defects. Autologous costal cartilage grafts are commonly used to provide nasal tip support. This study aims to evaluate the efficacy and safety of a modified technique using a lollipop-like cartilage graft with a peach-shaped head.

METHODS

A retrospective review was conducted on Chinese patients who underwent primary rhinoplasty with the modified technique between November 2018 and March 2021 at our center. Preoperative and postoperative facial photographs, patient-reported outcome measures including the visual analog scale (VAS) and the rhinoplasty outcome evaluation (ROE), as well as surgery-related complications, were collected for outcome assessment.

RESULTS

A total of 31 adult patients were included in this retrospective cohort study, with a mean follow-up period of 17.12 ± 3.89 months. The majority of patients (28/31; 90.3%) expressed satisfaction with the aesthetic outcomes, as evidenced by a significant increase in mean VAS score from 3.97 ± 1.52 preoperatively to 7.39 ± 0.22 postoperatively (P < 0.01), and a significant increase in mean ROE score from 11.77 ± 2.33 to 17.22 ± 2.47 (P < 0.01). Photogrammetric analysis also demonstrated significant improvements in nasal anatomical measurements. Among the three patients with unsatisfactory feedback, two had mild columella deviations and one had a mild dorsum deviation. No other notable complications were reported.

CONCLUSION

The current study supports the safety and utility of the modified technique utilizing the lollipop-like costal cartilage graft with a peach-shaped head for major tip refinement in East Asian patients.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A New Algorithm for Secondary Repair of Unilateral Cleft Lip Nasal Deformity

OBJECTIVES

Following primary surgery for unilateral cleft lip palate (UCLP), cleft lip nasal deformities (CLNDs) (nasal asymmetry, collapsed nasal alae, and a widened alar base) are generally inevitable and often require secondary rhinoplasty. However, reconstructing a cleft nose with an alar tissue deficiency remains challenging for rhinoplasty surgeons.

METHODS

The manifestations of common deformities are described herein, and a secondary rhinoplasty technique for unilateral CLNDs using a nasolabial flap (NLF) has been proposed for patients with alar tissue deficiency. Secondary rhinoplasties were performed in 12 patients with unilateral CLNDs between 2020 and 2021 using a NLF. Photogrammetric measurements were performed preoperatively and postoperatively. A total of 12 flaps were successfully transferred. Ten patients were followed up for >1 year.

RESULTS

Significant postoperative decreases in nasal alar width were measured in both the base view (p < 0.050) and the frontal view (p < 0.050). Despite the additional facial scars that occurred in some cases, all patients were satisfied with the aesthetic effects.

CONCLUSIONS

The NLF achieved satisfactory results in secondary rhinoplasty of unilateral CLND for patients with nasal tissue deficiencies in whom the surgeon weighed the potential benefits over postoperative scarring.

LEVEL OF EVIDENCE

4 Laryngoscope, 134:1648-1655, 2024.

Current Surgical Outcomes of Nasal Tip Grafts in Rhinoplasty: A Systematic Review

BACKGROUND

Refinement of the nasal tip plays an important role in rhinoplasty surgery outcomes and may be considered the most technically challenging aspect of the procedure. Numerous techniques have been described for nasal tip augmentation utilizing grafts. The aim of this study was to systematically review the existing literature on nasal tip grafts and appraise it critically.

METHODS

A PubMed search was performed to identify journal articles related to nasal tip grafts from the past decade. A total of 44 studies met inclusion criteria. The Newcastle-Ottawa Quality Assessment Scale and Jadad scale were used to appraise 38 observational studies and six randomized trials, respectively, to determine the quality of the studies.

RESULTS

Critical assessment revealed that the studies were highly variable in focus and encompassed autologous, homologous, and alloplastic grafts. The quality of the data included an average Newcastle-Ottawa Quality Assessment Scale score of 6.5 (out of 9) and Jadad score of 2.5 (out of 5). A majority of studies (86.4%) included objective outcomes using anthropometric measurements and a portion of studies (27.3%) also included patient-reported outcomes.

CONCLUSIONS

The results of this systematic review suggest that more than one type of nasal tip graft may result in satisfactory outcomes. This review provides an expansive collection of studies on nasal tip grafts, which can serve as an invaluable tool for the plastic surgeon engaging in rhinoplasty.

Complications Associated with Autologous Costal Cartilage Used in Rhinoplasty: An Updated Meta-Analysis

OBJECTIVE

To estimate the complications using autologous costal cartilage as grafts in rhinoplasty objectively and systematically with newly published literature.

METHODS

The literature was searched systematically; included studies were published between July of 1990 and April of 2020. Meta-analysis was performed using a random-effects model.

RESULTS

Twenty studies involving 1648 patients were included for meta-analysis. The pooled rates of complications were 3.05% of warping (95% CI 1.36-5.19%), 1.2% of resorption (95% CI 0.26-2.56%), 1.45% of infection (95% CI 0.34-3.06%), and 1.53% of contour irregularity (95% CI 0.53-2.88%). The revision rate was 2.25% (95% CI 0.96-3.9%). Regarding of donor-site morbidities, the rate of hypertrophic chest scar was 2.08% (95% CI 0.31-4.83%), and the rate of pneumothorax was 0% (95% CI 0-0.46%). The pooled rates of complications were 9.06% (95% CI 6.13-12.43%) at the recipient site when complications at the recipient site did not include revision surgery, 1.47% (95% CI 0.17-3.56%) at the donor site, and 15.13% (95%CI 11.03-19.69%) overall. The recipient-site adverse event rate was 12.44% (95% CI 8.98-16.33%).

CONCLUSIONS

Warping was found the most common complication after rhinoplasty with autologous costal cartilage. Revision after rhinoplasty using autologous costal cartilage was increased in these years. Donor-site complications increased the complication rate after rhinoplasty using autologous rib cartilage by 22%.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

[Research progress of autogenous cartilage scaffold carving method in rhinoplasty]

OBJECTIVE

To summarize the research progress of autogenous cartilage scaffold carving method in rhinoplasty.

METHODS

The relevant literature about the autogenous cartilage scaffold carving methods in rhinoplasty in resent years at home and abroad was reviewed, and the carving skills, shape, and application scope of different parts of nasal scaffolds were summarized and analyzed.

RESULTS

Willow-leaf shape is still the main method of cartilage scaffold in the back of the nose. However, in nasal reconstruction, it can be carved into an L-shaped scaffold with the nasal columella scaffold through mortise and tenon structure. And it can also crush the autologous cartilage and wrap it with the autologous fascia tissue to form a new nasal dorsal scaffold. The nasal tip scaffold is improved by changing the shape of traditional nasal tip cartilage cap and wrapping with fascia tissue; the nasal alar scaffold has M-shape, q-shape, carving methods; the nasal columella and nasal septum are mostly used "2+2" combined fixed scaffold. The cartilage scaffolds of lateral nose and nasal base are mainly carved in the shape of "" and crescent.

CONCLUSION

As a rhinoplasty scaffold, there are various carving methods for autogenous cartilage. With the innovation of surgical technique and the improvement of sculpting technique, the effect of autologous cartilage graft in rhinoplasty is getting better and better; meanwhile, tissue engineered cartilage is being applied in rhinoplasty.