Multilayered Costal Cartilage Graft for Nasal Dorsal Augmentation

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

Layered Composite Dorsal Onlay Implant for Augmentation Rhinoplasty

The use of autologous costal cartilage in augmentation rhinoplasty is well-established. However, scenarios where costal cartilage is insufficient or patients are unwilling to undergo additional cartilage harvesting present a challenge. This study introduces a composite dorsal onlay implant, combining silicone and costal cartilage, as an effective solution. Twenty female patients were enrolled in this study. Of these patients, 8 underwent revision surgery who had previous rhinoplasty with costal cartilage graft, and 12 had never previously undergone surgery involving the harvesting of costal cartilage. The implant, created by suturing a silicone base with a costal cartilage overlay, demonstrated low rates of warping and translucency over a mean follow-up of 11.4 months. This method offers a refined nasal appearance, particularly a higher dorsum with reduced translucency for patients with limited costal cartilage availability.

Rhinoplasty Exclusively Utilizing Autologous Costal Cartilage for Patients with Prior Unilateral Cleft Lip Repair

Background

Rhinoplasty in patients with previous unilateral cleft lip repair is a surgical challenge due to complex nasal deformities, including a horizontally positioned nasal wing, wide cleft side nostrils, nasal base defects, and a short and deviated nasal columella. To comprehensively address these complexities, we exclusively utilized autologous costal cartilage in rhinoplasty procedures, using various surgical techniques.

Methods

This study presents a comprehensive case series of 39 patients who had previously undergone unilateral cleft lip surgery but still had nasal deformities. Rhinoplasty using autologous costal cartilage was performed at Cho Ray Hospital, Vietnam. Costal cartilage was partially crushed and then finely cut to shape the dorsal area and raise the nasal base on the cleft side. Partially crushed cartilage was also used to shape shield grafts, cap grafts, and alar batten grafts, whereas sliced cartilage was utilized for septal extension grafts. Evaluation was based on improvements in anthropometric indicators, patient satisfaction using Rhinoplasty Outcome Evaluation (ROE) scale and FACE-Q scores.

Results

The average age of patients was 25.13 years. All postoperative anthropometric indicators showed significant improvements. Postsurgery, the total ROE score was three times higher than before surgery (P < 0.001), and the total FACE-Q score was 2.26 times higher (P < 0.001). No significant intraoperative or postoperative complications were observed.

Conclusions

This procedure effectively addresses complex nasal deformities in patients with prior unilateral cleft lip repair, emphasizing the value of autologous costal cartilage in rhinoplasty for such individuals.

The current techniques in dorsal augmentation rhinoplasty: a comprehensive review

BACKGROUND

An essential aspect of rhinoplasty is the enhancement of the nasal dorsal contour by performing dorsal augmentation (DA) rhinoplasty. A wide range of techniques are available for DA as the demand for aesthetic nasal refinement grows. This review aims to provide a comprehensive overview of the current techniques used in DA rhinoplasty.

MAIN BODY

Research articles on DA rhinoplasty techniques were identified through a comprehensive literature search. Scopus, PubMed, and Web of Science were used as electronic databases. Each database was searched for articles published since its inception. DA rhinoplasty techniques were examined in this literature review. Methodological quality was assessed for the selected studies, and data was extracted to examine materials used, surgical approaches, and reported outcomes for each technique. Various DA methods, including autologous grafts and synthetic implants, are examined in-depth in this review. Comparing approaches can help better understand their respective advantages and limitations.

CONCLUSION

A wealth of techniques is available for DA rhinoplasty, each with advantages. Patients' nasal anatomy, desired outcomes, and potential risks must be considered by surgeons when determining their surgical approach. DA methods continue to evolve rapidly, creating a need for a thorough understanding of the current landscape to make informed decisions.

Enhanced revision rhinoplasty with processed costal cartilage guided by preoperative computed tomography and 3D scanning

BACKGROUND

Revision rhinoplasty presents unique challenges, particularly in achieving structural integrity and aesthetic harmony. This study explores the efficacy of costal grafts in addressing these challenges, focusing on anatomical corrections and patient outcomes.

MATERIALS AND METHODS

A prospective analysis was conducted on patients undergoing revision rhinoplasty with costal grafts. An algorithmic approach was applied to tailor the surgical technique to individual anatomical needs, documented through pre- and postoperative assessments, including CT imaging and 3D scanning.

RESULTS

A total of 34 patients were included. Significant improvements were noted in nasal structure and function post-surgery. The mean NOSE score improved from 94.47 ± 5.48 preoperatively to 12.59 ± 13.43 postoperatively, and the mean ROE score increased from 18.44 ± 10.02 to 92.65 ± 13.00, indicating substantial enhancement in both nasal airway function and patient satisfaction. The use of costal grafts facilitated effective corrections for a broad spectrum of nasal deformities, with a complication rate of 2.94%.

CONCLUSIONS

Costal grafts in revision rhinoplasty offer a versatile and effective solution for complex nasal deformities. The algorithmic approach used in this study enhances repeatability and outcomes, suggesting a promising avenue for achieving desired aesthetic and functional results in revision cases. Further research is warranted to optimize techniques and evaluate long-term outcomes.

LEVEL OF EVIDENCE

II.

Outcomes of Open Rhinoplasty for Unilateral Cleft Patients using Photogrammetric Analysis - An Evaluative Study

Introduction

Secondary cleft rhinoplasty is a challenge due to the complex anatomy of the nose, with structural deformity and difficulty in surgical management. This study aimed to evaluate the effect of an anatomical-based approach on enhancing tip and alar symmetry in secondary unilateral cleft rhinoplasty using photogrammetric evaluation.

Methods

The study was conducted on 57 adult patients seeking rhinoplasty after primary repair of congenital unilateral cleft lip deformity. All patients were operated upon using an external open rhinoplasty approach using an anatomical-based surgical technique. The cases were periodically followed up at three, six, 12 and 18 months for both aesthetic and functional outcomes with photogrammetric analysis of facial profile using the software Mirror Suite programme to compare before and after the surgical procedure.

Results

The photogrammetric analysis showed a significant improvement of facial angles (P = 0.05). The nasofrontal angle changed from a median of 146° to 132.5°, nasolabial angle of 73° to 95°, nasofacial angle of 21.5° to 32° and nasomental angle of 105° to 130°. The rotation angle of the nasal tip showed a significant cephalic rotation with a mean increase of the tip elongation of 1.8 cm achieved per lateralised millimetre.

Discussion

Secondary rhinoplasty in unilateral cleft deformities needs accurate evaluation of the anatomical and pathological abnormalities. Open approach is preferred with using costal cartilage graft allowing adequate columellar lengthening, maxillary enhancement and alar repositioning which leads to optimise the definition, projection and cephalic rotation with better stabilisation and symmetry of the nasal tip.

Cosmetic Augmentation Rhinoplasty for East Asians

Symmetric pocket formation and meticulous implant carving are the most critical parts of nasal dorsal augmentation using implants. Innovative three-dimensional printed nasal implants can exactly fit the nasal dorsal contour, decreasing the chance of deviation and malpositioning. Vertically oriented folded dermal graft technique can avoid the high resorption rate of conventional dermofat grafts. Multilayered costal cartilage graft technique for dorsal augmentation can minimize warping and difficulty in the graft carving. Derotation graft allows supple and movable nasal tip while enabling enough tip lengthening, even if the septal extension graft is the most commonly performed procedure for short nose correction.