Autologous vs Irradiated Homologous Costal Cartilage as Graft Material in Rhinoplasty

Wee JH, Mun SJ, Na WS, Kim H, Park JH, Kim DK, Jin HR.

PubMed 28334327 Publisher (DOI)Free full text (PMC)

What this paper says

Comparing 63 patients grafted with their own rib cartilage against 20 grafted with irradiated donor rib cartilage, notable resorption occurred in 3 percent versus 30 percent and aesthetic satisfaction was much higher with the patient's own cartilage.

Overview

Major augmentation of the nose needs a large amount of cartilage, usually taken from the patient's rib. Donor rib cartilage from a cadaver, sterilized by radiation, avoids the chest incision. This retrospective study compared complications, satisfaction, objective outcome scores, and the microscopic structure of the two materials.

Sections of note

Retrospective study of rhinoseptoplasty performed from January 1, 2009, to December 31, 2014, with follow-up over 1 year.
63 patients used their own rib cartilage, 27 male and 36 female, mean age 30.6 years, SD 9.5.
20 patients used irradiated donor rib cartilage, 9 male and 11 female, mean age 35.4 years, SD 15.4.
Notable resorption was the only complication differing significantly: 6 of 20 (30 percent) with donor cartilage versus 2 of 63 (3 percent) with the patient's own, P .002.
Aesthetic satisfaction: 37 of 51 (73 percent) very satisfied with their own cartilage versus 6 of 20 (30 percent) with donor cartilage, P .001.
Functional satisfaction did not differ significantly between the groups.
Objective Rhinoplasty Outcome Score exceeded 3.1, between good and excellent, for both materials.
Microscopically, the patient's own cartilage had larger, more evenly distributed, uniform cartilage cells and more collagen and proteoglycan. Level of evidence 3.

What it means for a patient

Donor rib cartilage avoids a chest scar but shrank noticeably in nearly a third of cases here.
Breathing results were similar with either material; the difference was in appearance and durability.
Both materials scored between good and excellent on the objective grading.
Limits: retrospective, unequal groups of 63 and 20, one center, not randomized, and follow-up stated only as more than 1 year.

Why this paper matters

Irradiated donor cartilage is attractive because it removes the rib harvest, and reported resorption rates have varied widely. This study pairs clinical outcomes with tissue analysis showing structural differences. The small donor group leaves the long-term resorption rate uncertain.

Terms

Autologous costal cartilage: Rib cartilage taken from the patient's own chest.
Irradiated homologous costal cartilage: Donor rib cartilage from a cadaver, sterilized with radiation.
Resorption: Gradual absorption and shrinkage of a graft by the body.
Rhinoseptoplasty: Combined reshaping of the nose and correction of the septum.
Proteoglycan: A molecule in cartilage that helps it hold water and resist compression.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

Abstract

Importance: Studies comparing surgical results of rhinoplasty using autologous costal cartilage (ACC) and irradiated homologous costal cartilage (IHCC) are rare.

Objectives: To compare the clinical results of major augmentation rhinoplasty using ACC vs IHCC and analyze the histologic properties of both types of cartilage.

Design, Setting, And Participants: A retrospective clinical study was conducted among patients who had undergone rhinoseptoplasty using ACC or IHCC from January 1, 2009, to December 31, 2014. Patients were followed up for more than 1 year after surgery and the histologic characteristics of ACC and IHCC were compared. The details of the surgical procedures and complications, including warping, infection, resorption, and/or donor-site morbidity, were evaluated by reviewing medical records and facial photographs. Patients' subjective satisfaction with aesthetic and functional results was evaluated using a questionnaire.

Main Outcomes And Measures: The details of the surgical procedures and complications, including warping, infection, resorption, and/or donor-site morbidity; patients' subjective satisfaction with aesthetic and functional results' objective evaluation of surgical outcomes, including symmetry, dorsal height, dorsal length, dorsal width, tip projection, tip rotation, tip width, and overall result; and histologic structures. Objective evaluation of surgical outcomes was graded using the Objective Rhinoplasty Outcome Score, which assessed symmetry, dorsal height, dorsal length, dorsal width, tip projection, tip rotation, tip width, and overall result. Histologic structures were evaluated using hematoxylin and eosin, Masson trichrome, Alcian blue, and Verhoeff elastic stains.

Results: A total of 63 patients (27 males and 36 females; mean [SD] age, 30.6 [9.5] years) had rhinoseptoplasty using ACC and 20 (9 males and 11 females; mean [SD] age, 35.4 [15.4] years) had rhinoseptoplasty using IHCC. Among observed complications, only notable resorption occurred more frequently in patients using IHCC (6 [30%]) than with ACC (2 [3%]) (P = .002). In subjective evaluations of aesthetic satisfaction, patients who received ACC showed significantly greater satisfaction (37 of 51 patients [73%] were very satisfied) than did those who received IHCC (6 of 20 [30%]) (P = .001). However, there was no between-group difference in subjective functional outcomes: 4 of 51 patients receiving ACC (8%) and 5 of 20 receiving IHCC (25%) were satisfied (P = .50) and 45 of 51 receiving ACC (88%) and 15 of 20 receiving IHCC (75%) were very satisfied (P = .15). Regarding objective aesthetic outcomes, all scores for both ACC and IHCC were more than 3.1 (between good and excellent). Histologic analyses showed larger, more evenly distributed, uniform chondrocytes and more collagens and proteoglycan contents in ACC than in IHCC.

Conclusions And Relevance: Compared with patients receiving IHCC, those receiving ACC for rhinoseptoplasty showed superior aesthetic satisfaction; ACC also had less frequent notable resorption. Autologous costal cartilage also had better histologic properties than IHCC did, suggesting it as an ideal graft material with less chance of long-term resorption.

Level Of Evidence: 3.

Abstract as indexed by PubMed; the article is open access (PubMed Central).