Outcomes following rhinoplasty using autologous costal cartilage

Overview

Rib cartilage is the graft of choice when a nose needs major rebuilding, but few studies had measured how patients and surgeons rate the results or how often problems occur. The authors reviewed five years of rib cartilage rhinoplasty at a Korean center, collected patient self-ratings and independent surgeon ratings, and counted complications.

Sections of note

• Retrospective review of 108 patients, April 2006 to May 2011; 81 men, 27 women; mean age 33.0.
• Patient self-assessment: 73 satisfied, 16 felt better than before, 19 dissatisfied.
• Two independent surgeons rated photographs: 43 excellent, 37 good, 24 fair, 4 poor.
• Donor site complications, 13: 9 seromas, 1 pneumothorax, 2 keloids, 1 persistent pain.
• Recipient site complications, 19: 9 infections, 5 resorptions, 2 visible graft contours, 2 graft fractures, 1 warping.
• The authors conclude the complication rate is relatively high and aesthetic outcomes relatively poor.

What it means for a patient

• Rib cartilage rhinoplasty carries risks at the chest as well as the nose; about 1 in 8 patients here had a chest problem, usually a fluid collection, and 1 had a collapsed lung.
• About 1 in 6 patients were dissatisfied, and about 1 in 12 had a graft infection.
• Many of these patients were likely difficult revision or reconstruction cases, which the abstract does not detail; results may not apply to first-time surgery.

Why this paper matters

Most rib cartilage papers report high success. This one, from a major Asian rhinoplasty center, reports honest and sobering rates and cautions against routine use. Which patient factors predicted poor outcome is not stated in the abstract.

Terms

• Autologous costal cartilage: cartilage taken from the patient's own rib.
• Donor site: the chest wound where the rib cartilage was removed.
• Seroma: a collection of clear fluid under the skin after surgery.
• Pneumothorax: air leaking into the chest cavity, causing partial lung collapse.
• Keloid: a raised, overgrown scar.
• Warping: a cartilage graft bending after it is placed.