Prospective Clinical Trial Evaluating the Outcomes Associated with the Use of Fresh Frozen Allograft Cartilage in Rhinoplasty

Overview

Every graft option in rhinoplasty trades off differently between shape, donor site pain and durability. The authors compared fresh frozen cadaveric costal allograft against traditional autologous rib cartilage in cosmetic and reconstructive rhinoplasty. Shape stability was measured by how much standardized photographic angles drifted between the 6 month and 12 month visits, since warping, shrinkage or displacement would show as change.

Sections of note

• Design: prospective, single center, nonrandomized, open label clinical trial.
• 50 eligible patients enrolled between March 2017 and October 2020. Average age 43.9 years, mean follow up 14.8 months.
• Photographic measures: deviation angle, nasofrontal angle, total facial convexity, nasofacial angle and nasolabial angle, with change taken as the absolute difference between the 6 and 12 month values.
• In the control group using the patient's own cartilage, drift in deviation angle and nasolabial angle was greater than in the donor cartilage group, p less than 0.05.
• FACE-Q satisfaction with nose improved in the donor cartilage group at 6 months and 1 year, p less than 0.05, with nostrils and overall facial appearance also improved at 6 months.
• Complications occurred in 6 donor cartilage patients and 10 control patients.

What it means for a patient

• Donor rib cartilage avoids a chest incision, which removes the pain and scarring of harvesting your own rib.
• The donor grafts drifted less in shape over the second half of the first year on two of five measures.
• Limits: not randomized and open label, so patients and surgeons knew which graft was used, and the abstract does not state the size of each group.
• Follow up averaged under 15 months. Resorption of donor cartilage typically shows over years.

Why this paper matters

Whether banked donor cartilage matches the patient's own has been argued for decades, mostly on case series. A prospective comparative trial with photographic measurement is a step up in evidence quality. Whether the difference persists past a year, and how it affects revision rates, is unanswered.

Terms

• Allograft: tissue from a human donor, here processed cadaveric rib cartilage.
• Autologous: taken from the patient's own body.
• Costal cartilage: cartilage from the ribs, harvested for use as a graft.
• Warping: bending or curling of a cartilage graft after placement.
• Open-label: a study in which everyone knows which treatment was given.
• FACE-Q: a validated questionnaire measuring satisfaction with facial appearance.