Safety of Irradiated Homologous Costal Cartilage Graft in Cleft Rhinoplasty

Overview

The patient's own cartilage carries a low risk of infection and extrusion in cleft rhinoplasty, but harvesting it creates a second wound and lengthens anesthesia. The study tested whether irradiated donor rib cartilage is a comparable alternative. Records were reviewed retrospectively for patients with a history of cleft lip who had rhinoplasty for cleft nasal deformity at Johns Hopkins Hospital from 2009 to 2018, excluding operations without a cartilage graft.

Sections of note

• Retrospective study of 165 cleft rhinoplasties; age 2 to 72 years, 52 percent female; level of evidence III.
• Median follow up was 256 days; 30 percent were revision operations.
• Ninety six procedures, 58 percent, used irradiated donor rib cartilage; the rest used the patient's own cartilage.
• Complications occurred in 18 procedures, 11 percent overall: 7 of the own cartilage group, 10 percent, and 11 of the donor group, 12 percent.
• Eighty six percent of own cartilage complications needed another operation, versus 7 of 11, 64 percent, in the donor group.
• Donor cartilage complications were infection in 5, warping in 2 and extrusion in 1.
• Own cartilage complications were collapse in 2, and one each of resorption, warping and thickened donor site scar.
• Neither complication rate nor need for reoperation differed significantly, P equals 0.3 and P equals 0.5.

What it means for a patient

• Donor cartilage avoids a chest incision and its scar, which matters in children having repeated operations.
• Infection was the leading problem with donor cartilage; graft collapse and donor scarring were the problems with the patient's own.
• Median follow up of 256 days is short for detecting late warping or resorption.
• This is a retrospective single centre study, not a randomized comparison.

Why this paper matters

Cleft nasal deformity usually requires several operations, so cartilage supply and donor site cost accumulate. This study finds no safety penalty for donor rib. Long term graft durability across repeated surgery is still unmeasured.

Terms

• Cleft rhinoplasty: nasal surgery in a patient born with a cleft lip and the associated nasal deformity.
• Autologous cartilage: cartilage taken from the patient's own body.
• Irradiated homologous costal cartilage: donor rib cartilage treated with radiation before use.
• Extrusion: a graft working its way out through skin or lining.
• Donor site morbidity: problems at the place the graft was taken from.