Complications in Functional Rhinoplasty Related to Cartilage Graft Source

Upton MK, Ortiz A, Neal E, Lee D, Patel PN, Yang SF, Stephan SJ.

What this paper says

In 259 functional rhinoplasties, revision was needed in 12.1% of patients grafted with fresh-frozen donor rib versus 4.0% with the patient's own cartilage, a four-fold higher odds after adjustment, with no difference in infection.

Overview

Functional rhinoplasty often needs cartilage for structural grafts. The authors reviewed patients treated from 2017 to 2022 with at least 6 months of follow-up, comparing autologous cartilage against fresh-frozen cadaveric rib (FFCR) on revision, infection and persistent obstruction, using chi-squared tests and multivariable logistic regression.

Sections of note

259 patients, mean age 43.1, 71.4% female; mean follow-up 12.3 months (range 6-54).
58 (22.4%) received FFCR.
Revision: 8 of 201 (4.0%) autologous versus 7 of 58 (12.1%) FFCR; overall 5.8%.
Persistent obstruction without surgery 6.6%; infection needing antibiotics or drainage 4.6%.
Logistic regression: FFCR associated with revision (p = 0.024, OR 4.0), not with infection (p = 0.101) or obstruction (p = 0.187).

What it means for a patient

Donor rib avoids a chest incision but in this study was linked to three times the revision rate.
Infection was not higher with donor cartilage.
If your own cartilage is insufficient, the authors advise a tailored discussion of the trade-offs.

Why this paper matters

It is a direct comparison of graft sources in a functional (not cosmetic) population, and its finding conflicts with some single-surgeon series favouring donor rib. Limits: retrospective, unequal groups, and the reported confidence interval for the odds ratio is inconsistent in the abstract.

Terms

Functional rhinoplasty: nasal surgery to improve breathing.
Fresh-frozen cadaveric rib (FFCR): donor rib cartilage preserved by freezing.
Autologous cartilage: the patient's own septal, ear or rib cartilage.
Odds ratio (OR): the relative odds of an event; 4.0 means four times the odds.
Multivariable logistic regression: a statistical method adjusting for several factors at once.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

From the abstract

“Functional rhinoplasty often relies on repurposed cartilage for nasal framework grafting. Objective: To compare complications in functional rhinoplasty associated with use of autologous versus fresh frozen cadaveric rib cartilage (FFCR). Methods: This retrospective cohort study included patients who underwent…”

Excerpt; the full abstract is on PubMed.