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

Overview

Revision rhinoplasty is difficult, and the difficulty increases when little septal cartilage remains for rebuilding the framework. Taking the patient's own rib lengthens the operation and can cause chest problems including contour irregularity, poor scarring and a collapsed lung. This retrospective review covered the senior author's patients from 2011 to 2020, including only revision cases using off the shelf fresh frozen donor cartilage with at least six months of follow up.

Sections of note

• Retrospective review; 226 patients met inclusion criteria; therapeutic level of evidence IV.
• All had open rhinoplasty with fresh frozen rib cartilage grafts.
• Mean follow up was 12.18 months, range 6 months to 8 years.
• Outcomes assessed were warping, resorption, displacement and infection.
• Fifty four percent of patients had undergone one previous rhinoplasty.
• Four percent had undergone four or more previous nasal procedures.
• The overall infection rate was 2.7 percent, six patients.
• Most infections, 2.3 percent, were successfully managed with antibiotics alone.

What it means for a patient

• Fresh frozen donor cartilage is available off the shelf, so no chest incision is required and no lung risk is taken.
• Infection occurred in about one patient in 37, and only one required more than antibiotics.
• The abstract reports rates only for infection; warping, resorption and displacement were assessed but their rates are not given.
• This is one surgeon's series with no comparison group receiving the patient's own or irradiated rib.

Why this paper matters

Cartilage supply is the limiting factor in revision rhinoplasty, and the choice is between a chest harvest and donor material. This nine year series reports on the fresh frozen option specifically. Its claimed advantage over the patient's own or irradiated rib is asserted rather than compared.

Terms

• Fresh frozen cadaveric rib: donor rib cartilage preserved by freezing rather than irradiation.
• Autologous costal cartilage: rib cartilage taken from the patient's own body.
• Warping: gradual bending of a cartilage graft after placement.
• Resorption: gradual absorption and loss of graft material by the body.
• Pneumothorax: air leaking into the chest cavity, which can collapse a lung.
• Revision rhinoplasty: surgery on a nose that has already been operated on.