Fresh Frozen Cartilage in Rhinoplasty Surgery: A Systematic Review of Outcomes

Kadhum M, Khan K, Al-Ghanim K, Castanov V, Symonette C, Javed MU.

PubMed 38528125 Publisher (DOI)Free full text (PMC)

What this paper says

Pooling four studies covering 554 patients, fresh frozen donor rib cartilage produced infection in 2 percent, warping in 1.4 percent and shrinkage in 0.5 percent.

Overview

Fresh frozen cadaveric cartilage is an alternative to harvesting the patient's own rib. The authors systematically reviewed the published evidence on its use in rhinoplasty, focusing on clinical and aesthetic outcomes. The methodology was registered in advance in the PROSPERO database and followed PRISMA reporting guidelines.

Sections of note

Design: systematic review, prospectively registered. Level of evidence III.
Four articles were included, covering 554 patients in total.
477 patients, 86 percent, were female. Mean age ranged from 35.8 to 40.6 years.
Mean follow up across studies ranged from 12.2 to 20.3 months.
Only one of the four articles had a suitable control group, using the patient's own rib graft.
Pooled complications: infection in 12 patients, 2 percent; warping in 8, 1.4 percent; resorption in 3, 0.5 percent.
Patients reported high satisfaction with low rates of revision procedures.
The authors state complication rates were comparable to previous reviews of the patient's own cartilage and of irradiated donor cartilage.

What it means for a patient

Frozen donor rib avoids a chest incision and, across these studies, had low rates of the three failure modes surgeons watch for.
Only one of the four studies compared it directly against the patient's own cartilage, so the comparison rests largely on rates from separate literatures.
Follow up across the studies averaged under two years, and resorption typically becomes apparent over longer periods.
The authors call for further work on both clinical and cost effectiveness against the current standard of the patient's own cartilage.

Why this paper matters

Banked donor cartilage would remove the main drawback of rib grafting if it proves durable, and it has spread faster than evidence has accumulated. Pooling 554 patients gives the largest available safety picture. Four studies with one control group is a thin base, and long term durability is still unmeasured.

Terms

Fresh frozen cartilage: donor cartilage preserved by freezing rather than chemical processing or radiation.
Autologous graft: tissue taken from the patient's own body.
Warping: bending or curling of a cartilage graft after placement.
Resorption: gradual absorption and loss of graft volume by the body.
PROSPERO: a public register where systematic review plans are recorded in advance.
PRISMA: a checklist governing how systematic reviews are searched and reported.

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

Abstract

Introduction: Cadaveric fresh frozen cartilage provides an enticing alternative to traditional autologous cartilage grafts. This review provides a systematic analysis of existing literature on the use of fresh frozen rib for in rhinoplasties and focuses on clinical and aesthetic outcomes.

Methods: The methodology was designed and registered in the PROSPERO database (CRD42023447166). The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline was used to perform this systematic review.

Results: Four articles were included, with a total of 554 patients. A total of 477 patients were female (86%). Mean age ranged between 35.8 and 40.6. Mean follow-up ranged from 12.2 to 20.3 months. Only one article had a suitable control (with autologous rib graft). Pooled complications rates were low. Infection occurred in 12 patients (2%), warping in 8 patients (1.4%) and resorption in 3 patients (0.5%).

Conclusion: Fresh frozen cartilage may be a safe and reliable alternative to autologous rib grafts. Complication rates were comparable to previous systematic reviews of autologous graft and irradiated allograft. Overall, patients reported high satisfaction rates with low rates of revision procedures. Further studies are required to assess both clinical and cost effectiveness against the current gold standard (autologous graft).

Level Of Evidence Iii: Rhinoplasty. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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