Late-Onset Inflammation in Asian Rhinoplasty Using Alloplastic Implants

Overview

Late onset inflammation can appear months or years after an uneventful rhinoplasty with an artificial implant. The study asked what distinguishes the scar capsule around implants that become inflamed from capsules that do not. Between April 2009 and May 2018, capsules from 39 patients were harvested and examined under the microscope, 21 from patients with late inflammation and 18 from patients without.

Sections of note

• Comparative histological study, 39 patients, level of evidence IV as assigned by the journal.
• Non healthy capsule group, 21 patients with late onset inflammation; healthy capsule group, 18 patients without.
• Four stains were used: hematoxylin and eosin, Masson's trichrome, colloidal iron and CD31.
• Hematoxylin and eosin and Masson's trichrome showed more edematous granulation tissue, more inflammatory cell content and a disorganized collagen layer in the inflamed group.
• Colloidal iron staining revealed mucin deposition in the inflamed group.
• CD31 positive cells lined the capsule in both groups, but those lining cells were damaged in the inflamed group.
• The authors conclude damaged capsules may play a crucial role in late onset inflammation.

What it means for a patient

• Nasal implants can become inflamed long after surgery has apparently healed well.
• The study suggests the problem lies in the scar capsule the body forms around the implant, not only in bacteria.
• This is an observational comparison of tissue already removed. It cannot show what came first, the capsule damage or the inflammation.
• Nothing here identifies which patients will develop the problem or how to prevent it.

Why this paper matters

Late inflammation is one of the reasons implant based augmentation is contested, and its cause has not been settled. This study supplies tissue level evidence pointing at capsule breakdown. Whether treating or preventing capsule damage would reduce the complication remains untested.

Terms

• Alloplastic implant: an artificial implant material used instead of the patient's own cartilage.
• Capsule: the layer of scar tissue the body forms around any implant.
• Granulation tissue: soft new tissue formed during healing and inflammation.
• Mucin: a gel like substance whose deposition here signals abnormal tissue.
• CD31: a stain marking the cells that line blood vessels and tissue surfaces.
• Histology: examination of tissue under a microscope.