Complications in Functional Rhinoplasty Related to Cartilage Graft Source

Background: Functional rhinoplasty often relies on repurposed cartilage for nasal framework grafting. Objective: To compare complications in functional rhinoplasty associated with use of autologous versus fresh frozen cadaveric rib cartilage (FFCR). Methods: This retrospective cohort study included patients who underwent functional rhinoplasty from 2017 to 2022 with 6 months of documented follow-up. The primary outcome measure was need for revision rhinoplasty. Secondary outcomes were infection and persistent nasal obstruction without revision surgery. Chi-squared and Fisher's exact tests were used for univariate analysis, and multivariable logistic regression was used to evaluate the relationship between revision surgery and covariates. Results: 259 patients (average age: 43.1 ± 16.2, 185/259 female [71.4%]) underwent functional rhinoplasty with an average of 12.3 months (range: 6-54 months) of documented follow-up. A total of 58 (22.4%) cases utilized FFCR for grafting. Overall, 15 (5.8%) patients required revision rhinoplasty (8/201 [4.0%] autologous versus 7/58 [12.1%] FFCR), while 17 (6.6%) had persistent postoperative nasal obstruction without further surgery and 12 (4.6%) had an infection requiring prescribed oral antibiotics or drainage. Compared to autologous cartilage, there was a significant association between the use of FFCR with revision rhinoplasty on logistic regression (p = 0.024, odds ratio: 4.0 [95% confidence interval: 0.17-2.61]) but not with postoperative infection (p = 0.101) or persistent nasal obstruction (p = 0.187). Conclusion: These findings suggest increased rates of revision surgery associated with the use of FFCR in functional rhinoplasty. In the setting of insufficient autologous cartilage, tailored discussions should take place regarding the risks and benefits of potential supplemental graft material.