Joo Hyun Park1, Hong Ryul Jin. 1. Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea.
Abstract
BACKGROUND: The authors present the senior author's experience and evolution of techniques with the use of autologous costal cartilage grafts in Asian rhinoplasty. METHODS: Eighty-three patients who had rhinoseptoplasty with autologous costal cartilage grafts were included in this retrospective review. The types of grafts, complications related to the graft itself and graft harvesting, surgical outcome, and patient satisfaction were evaluated. The techniques of graft carving and cartilage harvesting were also reviewed. RESULTS: The mean postoperative follow-up duration was 29.5 months. Of 83 cases, 39 were revision cases. Autologous costal cartilage grafts were used for the dorsum in 83 cases, for the tip in 66 cases, for the septum in 58 cases, and for the ala in 23 cases. The complication rate related to grafts was 12 percent, which included five warped grafts and five infections. All infections were controlled with intravenous antibiotics. Two patients who had infection developed mild resorption of the grafts. Graft exposure, mobility, or significant resorption was not observed. Two patients underwent revision surgery for aesthetic dissatisfaction and one was planned. The length of chest incision for graft harvesting was 2.4 cm on average. There was no pneumothorax or significant donor-site pain. The donor-site scar was minimal, although two patients developed a hypertrophic chest scar. Overall, functional and aesthetic outcome was satisfactory in most patients. CONCLUSIONS: Autologous costal cartilage grafts in Asian rhinoplasty is a versatile and reliable graft material for both primary and revision cases. Even with minimal complications and morbidities, the possibility of warping in dorsal onlay grafts and the possibility of infection in revision surgery need attention. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
BACKGROUND: The authors present the senior author's experience and evolution of techniques with the use of autologous costal cartilage grafts in Asian rhinoplasty. METHODS: Eighty-three patients who had rhinoseptoplasty with autologous costal cartilage grafts were included in this retrospective review. The types of grafts, complications related to the graft itself and graft harvesting, surgical outcome, and patient satisfaction were evaluated. The techniques of graft carving and cartilage harvesting were also reviewed. RESULTS: The mean postoperative follow-up duration was 29.5 months. Of 83 cases, 39 were revision cases. Autologous costal cartilage grafts were used for the dorsum in 83 cases, for the tip in 66 cases, for the septum in 58 cases, and for the ala in 23 cases. The complication rate related to grafts was 12 percent, which included five warped grafts and five infections. All infections were controlled with intravenous antibiotics. Two patients who had infection developed mild resorption of the grafts. Graft exposure, mobility, or significant resorption was not observed. Two patients underwent revision surgery for aesthetic dissatisfaction and one was planned. The length of chest incision for graft harvesting was 2.4 cm on average. There was no pneumothorax or significant donor-site pain. The donor-site scar was minimal, although two patients developed a hypertrophic chest scar. Overall, functional and aesthetic outcome was satisfactory in most patients. CONCLUSIONS: Autologous costal cartilage grafts in Asian rhinoplasty is a versatile and reliable graft material for both primary and revision cases. Even with minimal complications and morbidities, the possibility of warping in dorsal onlay grafts and the possibility of infection in revision surgery need attention. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
Authors: Peter M Vila; Latoya M Jeanpierre; Christopher J Rizzi; Lauren H Yaeger; John J Chi Journal: JAMA Otolaryngol Head Neck Surg Date: 2020-04-01 Impact factor: 6.223