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

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.