Different Preparations of Cadaveric Costal Cartilage Compared to Autologous Rib Cartilage in Rhinoplasty: A Systematic Review and Meta-Analysis

Wael Moftah A, Samy Gad A, Sleiay M, Eid Abdelaziz N.

What this paper says

Pooling seven studies and 1,184 patients, donor rib cartilage matched the patient's own rib on infection and, when fresh-frozen, on warping and resorption, while irradiated donor cartilage resorbed 4.6 times more often.

Overview

Reports on donor (homologous) rib cartilage conflict partly because studies lump irradiated and fresh-frozen grafts together. This PRISMA 2020 review (PROSPERO CRD42025603758) separated preparations and compared each against autologous rib on resorption, warping and infection. Bias was assessed with Newcastle-Ottawa and ROBINS-I.

Sections of note

Seven studies, 1,184 patients.
Infection: no difference (RR 0.701; 95% CI 0.284-1.731).
Warping: alcohol-preserved grafts warped less than autologous (RR 0.106; 95% CI 0.012-0.934); fresh-frozen and irradiated matched autologous.
Resorption: irradiated grafts resorbed more (RR 4.595; 95% CI 1.279-16.503); fresh-frozen (RR 1.588) and alcohol-preserved (RR 1.479) did not differ significantly.
Operative time was 66.56 minutes shorter with donor cartilage (95% CI -81.42 to -51.71).

What it means for a patient

Donor rib avoids a chest incision and cut about an hour from surgery in the pooled data.
The type of processing matters: irradiated cartilage had a clear resorption problem; fresh-frozen did not.
The authors call donor cartilage a viable option in selected cases, "rather than a default substitute."

Why this paper matters

It is the first meta-analysis to separate donor cartilage by preparation method, resolving some of the conflicting literature. Limits: seven observational studies, wide confidence intervals, short-term outcomes only.

Terms

Homologous costal cartilage (HCC): rib cartilage from a deceased human donor.
Resorption: the body gradually absorbing a graft so it loses volume.
Warping: bending of a cartilage graft after placement.
Risk ratio (RR): the event rate in one group divided by the other; 1 means no difference.
ROBINS-I: a tool for judging bias in non-randomised studies.

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

From the abstract

“The adoption of homologous costal cartilage (HCC) in rhinoplasty is hindered by conflicting reports on resorption and warping. Current literature often conflates fresh-frozen and irradiated grafts, obscuring distinct biological profiles. The objective of this systematic review and meta-analysis was to evaluate the…”

Excerpt; the full abstract is on PubMed.