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Frozen Cadaveric Rib Grafts in Primary or Revision Rhinoplasty: A Systematic Review and Meta-analysis
Mohamed Amir Mrad1, Abdullah A Al Qurashi2,3, Qutaiba N M Shah Mardan3,4
1From the Plastic and Reconstructive Surgery Section, Department of Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Background:
Primary and secondary rhinoplasty frequently require cartilage grafts to support the osseocartilaginous framework. Autologous and irradiated homologous cartilage have been used as sources, each with pros and cons. Recently, fresh frozen cadaveric rib grafts have gained popularity, potentially reducing complications associated with autologous or homologous irradiated cartilage grafts. However, outcomes associated with these grafts have only been assessed in small studies. We conducted a meta-analysis to provide a comprehensive assessment of outcomes after primary and revision rhinoplasty using fresh frozen rib grafts.
Methods:
For this systematic review and meta-analysis, MEDLINE, Embase, Scopus, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched for articles published up to January 2023. Hybrid graft patients were excluded to ensure homogeneity. Data were pooled using a random-effects model and analyzed using Open Meta Analyst. Effect sizes were calculated for complications, including warping, resorption, infection, and revision surgery.
Results:
Of 306 citations, 5 studies were included in the meta-analysis. Our study, involving 440 patients, concluded a low overall complication rate but revealed a higher rate in studies with longer follow-up (7.6%; 95% confidence interval: 3.4%-13.3%) and in cases involving both primary and revision rhinoplasty (12.7%; 95% confidence interval: 4.8%-23.6%).
Conclusions:
This meta-analysis suggests that frozen cadaveric costal cartilage may be used for rhinoplasty with low complication rates. However, longer follow-up reveals higher complication rates (7.6%), and cases involving both primary and revision rhinoplasty show a complication rate of (12.7%). These findings emphasize the need for extended postoperative monitoring and caution when interpreting long-term outcomes.
