Safety and Efficacy of Non- and Minimally Irradiated Homologous Costal Cartilage in Primary and Revision Rhinoplasty

Importance: Despite favorable results with conventionally irradiated homologous costal cartilage, there have been no clinical studies to date evaluating the utility of non- or minimally irradiated homologous costal cartilage (NIHCC) in rhinoplasty. Objective: To evaluate the safety and efficacy of NIHCC in primary and revision rhinoplasty. Design, Setting, and Participants: We conducted a retrospective medical record review of patients undergoing primary and revision rhinoplasty between January 2010 and December 2014. Twenty-six patients who underwent primary or revision rhinoplasty with NIHCC were identified. Patient follow-up ranged from 2 to 43.2 months (mean 15.9 months) at the study took place in a single-center private practice, and surgery was performed by the two senior authors. Twenty-seven consecutive patients who underwent primary or revision rhinoplasty for functional and/or cosmetic concerns with NIHCC were identified. One patient was excluded due to concomitant use of GORE-TEX, leaving 26 patients for retrospective review. Seven patients underwent primary rhinoplasty and 19 patients underwent revision rhinoplasty. Main Outcomes and Measures: The purpose of this study is to demonstrate whether non- or minimally irradiated homologous rib cartilage used for primary and revision rhinoplasty has acceptable rates of warping, resorption, and infection. Results: A total of 26 patients underwent surgery with NIHCC; 20 (77%) were women, and the average patient age was 42 years (median 45 years). A total of 100 NIHCC grafts were used. Seven patients underwent primary rhinoplasty and 19 (73%) patients underwent revision rhinoplasty. The total complication rate related to grafts was 3.6%, which included 2 cases of partial noninfective resorption of 77 palpable or superficial grafts (2.6%), 1 infection of 100 grafts (1.0%), and zero cases of graft mobility and warping. Conclusion and Relevance: Non- or minimally irradiated homologous costal cartilage is safe and effective for grafting in primary and revision rhinoplasty, with low rates of resorption, infection, mobility, and warping. Further larger studies will need to be conducted to determine whether or not the reduced radiation improves outcomes compared with traditionally radiated homologous cartilage.