Frozen Cadaveric Rib Grafts in Primary or Revision Rhinoplasty: A Systematic Review and Meta-analysis

Mrad MA, Al Qurashi AA, Shah Mardan QNM, Halawani IR, Al Jabr FA, Alnafisi FN, Alkhalifah KM, Bamakhrama B, AlBattal NZ.

PubMed 40212098 Publisher (DOI)Free full text (PMC)

What this paper says

Pooling five studies covering 440 patients, frozen donor rib grafts had a low overall complication rate, rising to 7.6 percent in studies with longer follow up.

Overview

Rhinoplasty often needs cartilage grafts to support the framework, and the two established sources, the patient's own cartilage and irradiated donor cartilage, each carry drawbacks. Fresh frozen cadaveric rib has gained popularity as a potential improvement, but had only been assessed in small studies. The authors pooled the available evidence, searching five databases up to January 2023 and excluding hybrid graft patients.

Sections of note

Design: systematic review and meta-analysis using a random-effects model in Open Meta Analyst.
Of 306 citations, 5 studies were included, covering 440 patients.
Effect sizes were calculated for warping, resorption, infection and revision surgery.
Overall complication rate was low.
Complication rate in studies with longer follow up: 7.6 percent, 95 percent confidence interval 3.4 to 13.3 percent.
Complication rate in studies covering both primary and revision cases: 12.7 percent, confidence interval 4.8 to 23.6 percent.
Stated conclusion: extended postoperative monitoring is needed and long term outcomes should be interpreted with caution.

What it means for a patient

Frozen donor rib avoids a chest incision, and complication rates were low overall.
The important pattern is that longer follow up produced higher complication rates, which suggests problems accumulate with time rather than appearing early.
Studies mixing first time and revision cases reported the highest rate, at about 1 in 8, though revision cases are harder for reasons unrelated to the graft.
Limits: five studies, 440 patients, no comparison arm against the patient's own cartilage, and wide confidence intervals around both rates.

Why this paper matters

Banked donor rib is spreading quickly because it spares patients a rib harvest, and short follow up series have reported very low complication rates. This analysis shows those rates climb as follow up lengthens, which is the finding that matters for a graft meant to last decades. Direct comparison against autologous rib remains absent.

Terms

Fresh frozen cadaveric rib: donor rib cartilage preserved by freezing rather than radiation.
Autologous cartilage: cartilage taken from the patient's own body.
Irradiated homologous cartilage: donor cartilage sterilized by radiation.
Warping: bending or curling of a cartilage graft after placement.
Resorption: gradual absorption and loss of graft volume by the body.
Random-effects model: a pooling method that allows for real differences between studies.

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

Abstract

Background: Primary and secondary rhinoplasty frequently require cartilage grafts to support the osseocartilaginous framework. Autologous and irradiated homologous cartilage have been used as sources, each with pros and cons. Recently, fresh frozen cadaveric rib grafts have gained popularity, potentially reducing complications associated with autologous or homologous irradiated cartilage grafts. However, outcomes associated with these grafts have only been assessed in small studies. We conducted a meta-analysis to provide a comprehensive assessment of outcomes after primary and revision rhinoplasty using fresh frozen rib grafts.

Methods: For this systematic review and meta-analysis, MEDLINE, Embase, Scopus, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched for articles published up to January 2023. Hybrid graft patients were excluded to ensure homogeneity. Data were pooled using a random-effects model and analyzed using Open Meta Analyst. Effect sizes were calculated for complications, including warping, resorption, infection, and revision surgery.

Results: Of 306 citations, 5 studies were included in the meta-analysis. Our study, involving 440 patients, concluded a low overall complication rate but revealed a higher rate in studies with longer follow-up (7.6%; 95% confidence interval: 3.4%-13.3%) and in cases involving both primary and revision rhinoplasty (12.7%; 95% confidence interval: 4.8%-23.6%).

Conclusions: This meta-analysis suggests that frozen cadaveric costal cartilage may be used for rhinoplasty with low complication rates. However, longer follow-up reveals higher complication rates (7.6%), and cases involving both primary and revision rhinoplasty show a complication rate of (12.7%). These findings emphasize the need for extended postoperative monitoring and caution when interpreting long-term outcomes.

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