Challenges in Nasal Cartilage Tissue Engineering to Restore the Shape and Function of the Nose

The repair of nasal septal cartilage is a key challenge in cosmetic and functional surgery of the nose, as it determines its shape and its respiratory function. Supporting the dorsum of the nose is essential for both the prevention of nasal obstruction and the restoration of the nose structure. Most surgical procedures to repair or modify the nasal septum focus on restoring the external aspect of the nose by placing a graft under the skin, without considering respiratory concerns. Tissue engineering offers a more satisfactory approach, in which both the structural and biological roles of the nose are restored. To achieve this goal, nasal cartilage engineering research has led to the development of scaffolds capable of accommodating cartilaginous extracellular matrix-producing cells, possessing mechanical properties close to those of the nasal septum, and retaining their structure after implantation in vivo. The combination of a non-resorbable core structure with suitable mechanical properties and a biocompatible hydrogel loaded with autologous chondrocytes or mesenchymal stem cells is a promising strategy. However, the stability and immunotolerance of these implants are crucial parameters to be monitored over the long term after in vivo implantation, to definitively assess the success of nasal cartilage tissue engineering. Here, we review the tissue engineering methods to repair nasal cartilage, focusing on the type and mechanical characteristics of the biomaterials; cell and implantation strategy; and the outcome with regard to cartilage repair. Impact statement Nasal septal cartilage is key to the cosmetic and function of the nose. To repair important damage to the nasal septum, current surgical techniques are complex and limited by graft source availability. Conversely, tissue engineering is a promising strategy to reproduce the dimensions and mechanical properties of the nose without causing donor site morbidity. This approach, however, remains overlooked for the reconstruction of the nasal septum compared with other cartilaginous tissues. This review describes the specific challenges associated with nasal cartilage repair and the pioneering studies leading to advances in the growing field of nose tissue engineering.