PURPOSE: Autologous cartilage (AC) grafting is considered the gold standard for rhinoplasty for cleft nasal deformity as it is associated with a low risk of infection and extrusion. However, harvesting AC such as rib involves donor site morbidity and increased time under anesthesia. As irradiated homologous costal cartilage (IHCCs) grafts may have a similar complication profile as AC but without the donor site morbidity, they may be an effective alternative in patients with cleft nasal deformity.
METHODS: A retrospective study was performed on pediatric and adult patients with a history of cleft lip who underwent rhinoplasty for cleft nasal deformity at Johns Hopkins Hospital between 2009 and 2018. Patients were excluded if their rhinoplasty did not involve placement of an AC or IHCC graft.
RESULTS: A total of 165 cleft rhinoplasties (age 2–72 years, 73%; age <18 years, 52% female) were performed, using a mean of 3 cartilage grafts. Thirty percentage of these procedures were revision surgeries. Mean follow-up time was 407 days. Ninety-six (58%) procedures used IHCC, with the remaining utilizing AC. Complications resulted from 18 (11%) procedures: 7 (10%) involving AC and 11 (12%) involving IHCC grafts. Six of 7 AC complications (86%) required operative intervention, compared to 7 out of 11 (64%) for IHCC. The most common complications for IHCC and AC, respectively, were infection (n = 5) and collapse (n = 2). One AC procedure resulted in hypertrophic donor site scarring, 1 graft resorbed, and 1 warped; 1 IHCC graft extruded, none resorbed, and 2 warped. There was no difference between groups regarding complication rate or complications requiring operative intervention (P = 0.3, P = 0.5).
CONCLUSIONS: IHCC grafts are equally safe and effective as AC for use in rhinoplasty for cleft nasal deformity. These grafts are readily available and eliminate donor site morbidity.