A systematic review and meta-analysis of comparison of autologous costal cartilage and alloplastic materials in rhinoplasty

Publication date: Available online 11 April 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Xuebing Liang, Keming Wang, Sunitha Malay, Kevin C. Chung, Jiguang Ma
BackgroundBoth autologous costal cartilage (ACC) and alloplastic materials are widely used in rhinoplasty. However, there is controversy regarding which material can offer the ideal outcome and fewer complications.ObjectiveThe authors review current literature to evaluate complication and satisfaction rates with different materials in rhinoplasty.MethodsA comprehensive literature search was conducted in Embase and Pubmed of articles published through April 14, 2017. We included only articles that used ACC, silicone, Medpor, Gore-tex or a combination of autologous and alloplastic materials in rhinoplasty. The primary outcomes analysed were complications and post-operative satisfaction. After data extraction, meta-analysis using random effect model was performed to summarize outcome parameters among different implant types.ResultsFifty-three articles met inclusion criteria and were included in the meta-analysis. The overall complication rate of ACC was 14%, which was higher compared with other implants. However, ACC was more commonly used in revision rhinoplasty. Medpor was associated with low overall complication rates (6%) and good aesthetic and functional outcomes.ConclusionsOur analysis of available evidence suggests that ACC is preferred in revision rhinoplasty, which may explain its association with higher complication rates. In primary rhinoplasty, Medpor offered versatility in addition to low complication rates and good aesthetic and function outcomes. But its potential dramatic damage to nasal tissue made secondary surgery extremely difficult. Our findings were limited by lack of high quality evidence. Future studies with rigorous study design for head-to-head comparisons and longer follow-up are needed to establish clear guidelines for choosing the appropriate rhinoplasty graft material.