Fresh Frozen Rib Cartilage Grafts in Revision Rhinoplasty: A 9-Year Experience.

BACKGROUND

Revision rhinoplasty is undoubtedly one of the most challenging procedures in facial plastic surgery. The complexity is compounded when there is a paucity of native septal cartilage to perform the required framework reconstruction. Harvest of autologous costal cartilage can result in increased operative times and possible secondary-site complications such as contour irregularity, poor scarring, and even pneumothorax.

METHODS

A retrospective review was conducted of the senior author's (R.J.R.) patients from 2011 to 2020 who underwent primary or revision rhinoplasty. Inclusion criteria consisted of patients with fresh frozen off-the-shelf cartilage used in revision rhinoplasty only with a minimum of 6 months' follow-up. Outcomes for evaluation were warping, resorption, displacement, and infection.

RESULTS

The authors identified 226 patients who underwent open rhinoplasty with the use of fresh frozen rib cartilage grafts and met inclusion criteria. The mean follow-up period was 12.18 months (range, 6 months to 8 years). The majority of patients had undergone one prior rhinoplasty procedure (54 percent); however, 4 percent of patients had undergone four or more prior procedures on their nose. The overall infection rate was 2.7 percent ( n = 6), with the majority successfully managed with antibiotics alone (2.3 percent).

CONCLUSIONS

The results in revision rhinoplasty are significantly enhanced with the creation of a stable nasal framework using off-the-shelf, easily accessible, specifically tailored fresh frozen cadaveric rib grafts. The long-term outcomes and complication rate in this 9-year retrospective study demonstrates the safety of fresh frozen rib graft in comparison to autologous or irradiated rib graft.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.