Long-Term Complications from Diced Cartilage in Rhinoplasty: A Meta-Analysis

Overview

The study analysed how often long term complications and revision surgery follow the use of diced cartilage grafts to raise the nasal bridge. PubMed, MEDLINE, Embase and the Cochrane Central Register of Controlled Trials were searched for clinical studies on diced cartilage for dorsal augmentation, and a meta analysis pooled the estimated rates of infection, overcorrection, visible irregularity, absorption and revision.

Sections of note

• Systematic review and meta analysis; 14 studies involving 2,380 patients.
• The combined overall complication rate was 11.5 percent.
• The combined revision surgery rate was 5.3 percent.
• Infection was reported at 4.5 percent and visible irregularity at 5.3 percent.
• Overcorrection was reported at 0.7 percent and absorption at 0.5 percent.
• There was no significant difference in visible irregularity between wrapped, glued and free diced cartilage groups, P equals 0.23.
• There was no significant difference in revision surgery between those three groups, P equals 0.71.
• The authors state this is the first comprehensive quantitative report of long term complications for this technique.

What it means for a patient

• About one patient in nine had some complication and one in nineteen needed further surgery.
• Infection and visible irregularity were the two leading problems, at similar rates.
• Absorption of the cartilage, long the main objection to the technique, was rare at 0.5 percent.
• How the cartilage was packaged, whether wrapped in fascia, glued or placed free, made no measurable difference to irregularity or revision.

Why this paper matters

Diced cartilage is the standard material for raising and smoothing the bridge, and surgeons dispute whether it should be wrapped, glued or placed loose. This meta analysis finds no difference between those options and quantifies the underlying complication rates. The included studies were not randomized, so pooled rates carry that limitation.

Terms

• Diced cartilage: cartilage cut into small pieces so it can be shaped like a paste.
• Dorsal augmentation: raising the height of the nasal bridge.
• Wrapped diced cartilage: diced cartilage enclosed in a fascia sleeve.
• Overcorrection: a result with more height or volume than intended.
• Absorption: gradual loss of graft material into the body.
• Meta analysis: a statistical pooling of results from multiple studies.