Irradiated Homologous Costal Cartilage Grafts in Complex Functional Septorhinoplasty

Optimal results in complex nasal reconstruction, particularly in the context of post-traumatic and revision septorhinoplasty, often require the use of cartilage grafts to provide additional structural support to the nose. While autologous costal cartilage (ACC) has been traditionally used, this can be limited by donor site morbidity, increased operative time, and in some cases, lack of suitable cartilage for grafting. There has been a trend towards using irradiated homologous costal cartilage (IHCC) as an alternative source of graft material. We review our departmental experience of using IHCC in functional septorhinoplasty surgery. We performed a retrospective review of electronic medical records of all patients who underwent septorhinoplasty using IHCC at a tertiary referral center between May 1, 2022, and April 30, 2024. Demographic data, surgical details, and postoperative outcomes, including rates of infection, resorption, warping, and revision were recorded and analyzed. Fifty-seven patients (34 males, 23 females) with a mean age of 41.0 years (range: 18-65 years) were included. Forty-one were revision septorhinoplasty operations, while 16 were primary cases. Almost all were performed via an open approach (98.2%). Three patients developed postoperative infection (5.3%) while one developed columellar dehiscence needing further revision surgery (1.8%). Functional and aesthetic results were otherwise satisfactory in all patients. We observed no cases of warping, resorption, or extrusion. The median length of follow-up was 279 days (interquartile range: 171-527 days). We present the largest United Kingdom series to date on the use of IHCC in septorhinoplasty surgery. Our findings support its use as a safe and effective graft material and a viable alternative to autologous sources, offering the benefits of a robust reconstructive material and shortened operative time, without the risk of donor site complications. A longer follow-up period is ideally required to evaluate its long-term structural stability.