Liyanage Dinithi, Vayalapra Sushanth, Murdeshwar Himani, Suresh Jonathan James, Usman Hamza, Bailey-Lewis Elisha, Bailón-Valdez Zaira, Khajuria Ankur
Aesthet Surg J Open Forum. 2024 Dec 18;7:ojae122. doi: 10.1093/asjof/ojae122. eCollection 2025.
Autologous costal cartilage (ACC) is commonly used for dorsal augmentation rhinoplasty because of its availability and strength, despite risks such as hypertrophic scarring and pneumothorax for the patient. Irradiated homologous costal cartilage (IHCC) offers an alternative, potentially mitigating these complications. Previous reviews comparing these materials have been methodologically weak. The aim of this study is to perform a robust systematic review and meta-analysis comparing the outcomes of ACC and IHCC in dorsal augmentation rhinoplasty to guide clinical decision making in nasal reconstruction. Medline, Embase, Google Scholar, and the Cochrane Central Register of Controlled Trials databases were searched. Data extraction and quality assessment were performed by 2 independent authors. The primary outcomes of interest were warping, revision rates, infection rates, and displacement. Methodological quality and risk of bias were assessed using Grading of Recommendations Assessment, Development, and Evaluation and Cochrane's ROBINS I tool, respectively. Thirty-six articles were reviewed, including 1 comparative and 35 single-arm studies (ACC: 29, IHCC: 8), encompassing 2526 patients from 13 countries. Adverse events included warping (ACC: 6%, < .0001; IHCC: 6%, < .0001). Resorption rates were 1% for ACC ( = .06) and 3% for IHCC ( < .0001). Revision surgery rates were similar (ACC: 4%, < .001; IHCC: 4%, < .001), as were infection rates (ACC: 1.8%, = .03; IHCC: 1.3%, = .03). Current evidence does not demonstrate the superiority of ACC or IHCC for dorsal augmentation rhinoplasty. Both grafts are viable, with the choice guided by patient and surgeon preferences. Prospective, high-quality data with standardized outcomes are needed to improve clinical decision making.
自体肋软骨（ACC）因其可获取性和强度，常用于隆鼻术的鼻背增高，尽管对患者存在诸如肥厚性瘢痕和气胸等风险。辐照同源肋软骨（IHCC）提供了一种替代方案，可能会减轻这些并发症。先前比较这些材料的综述在方法上存在不足。本研究的目的是进行一项有力的系统评价和荟萃分析，比较ACC和IHCC在隆鼻术鼻背增高中的效果，以指导鼻再造的临床决策。检索了Medline、Embase、谷歌学术和Cochrane对照试验中央注册数据库。由两名独立作者进行数据提取和质量评估。主要关注的结果是弯曲、翻修率、感染率和移位。分别使用推荐分级评估、制定和评价以及Cochrane的ROBINS I工具评估方法学质量和偏倚风险。共审查了36篇文章，包括1项比较研究和35项单臂研究（ACC：29项，IHCC：8项），涵盖来自13个国家的2526名患者。不良事件包括弯曲（ACC：6%，P <.0001；IHCC：6%，P <.0001）。ACC的吸收率为1%（P =.06），IHCC为3%（P <.0001）。翻修手术率相似（ACC：4%，P <.001；IHCC：4%，P <.001），感染率也相似（ACC：1.8%，P =.03；IHCC：1.3%，P =.03）。目前的证据并未表明ACC或IHCC在隆鼻术鼻背增高方面具有优越性。两种移植物都是可行的，选择应根据患者和外科医生的偏好来指导。需要有标准化结果的前瞻性高质量数据来改善临床决策。
