Rib Grafts in Rhinoplasty: A Systematic Review and Meta-analysis of Autologous, Fresh-frozen, and Irradiated Cartilage.

BACKGROUND

Costal cartilage (CC) is a widely used graft material in rhinoplasty, harvested from autologous (ACC) or cadaveric sources, such as fresh-frozen (FFCC) or irradiated homologous costal cartilage (IHCC). Although all graft types carry risks of infection, warping, and revision surgery, their comparative safety profiles remain uncertain.

METHODS

A systematic review was performed in accordance with PRISMA guidelines. Multiple databases were searched from inception to April 2025 for studies evaluating outcomes of ACC, FFCC, or IHCC in rhinoplasty. Primary outcomes included infection, warping, and revision surgery. Data were pooled using random-effects proportional meta-analysis with heterogeneity assessed with I2.

RESULTS

Of 3109 records, 25 studies (n = 2322 patients) met inclusion criteria (ACC = 775, FFCC = 1076, and IHCC = 471). Infection rates were low across all graft types (1%-2%), with low heterogeneity. Warping was similarly infrequent (1%-3%), though moderate heterogeneity was observed across ACC studies. Revision rates demonstrated greater variability, ranging from 1% in FFCC to 7% in ACC and IHCC, with high heterogeneity and funnel plot asymmetry. Post hoc power analyses supported noninferiority of all graft types with respect to infection and warping.

CONCLUSIONS

Infection and warping are rare complications across graft types, suggestive of comparable safety profiles. Revision outcomes appeared most favorable with FFCC but were limited by heterogeneity and study design. These findings are suggestive of comparable safety profiles among ACC and cadaveric CC grafts. Higher-quality, prospective controlled studies with standardized outcome reporting and follow-up time are required to better inform graft selection.