Comparing autologous versus allogenic rib grafting in pediatric cleft rhinoplasty

Insalaco, Louis F.; Karp, Emily E.; Zavala, Hanan; Chinnadurai, Sivakumar; Tibesar, Robert J.; Roby, Brianne Barnett

doi:10.1016/j.ijporl.2020.110264

Cited by 6 publications

(7 citation statements)

References 15 publications

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“…Again, this was a bit surprising, and perhaps the ear cartilage grafts are taking the place of other, more complex cartilage shaping maneuvers in intermediate tip rhinoplasty. Rib cartilage grafts were significantly more likely to require inpatient admission than ear cartilage grafts ( P =0.003), consistent with previous studies citing increased pain, surgical time, and surgical risk of autologous costochondral cartilage harvest generally requiring postsurgical inpatient stay 8,23. Despite these shortcomings, autologous rib cartilage is advantageous given its strength and abundant supply compared with ear cartilage 24.…”

Section: Discussionsupporting

confidence: 82%

“…Rib cartilage grafts were significantly more likely to require inpatient admission than ear cartilage grafts (P = 0.003), consistent with previous studies citing increased pain, surgical time, and surgical risk of autologous costochondral cartilage harvest generally requiring postsurgical inpatient stay. 8,23 Despite these shortcomings, autologous rib cartilage is advantageous given its strength and abundant supply compared with ear cartilage. 24 Disadvantages of rib cartilage grafts include its potential for warping and calcium deposits.…”

Section: Discussionmentioning

confidence: 99%

“…Age cutoffs for appropriate timing of primary, intermediate, and late cleft rhinoplasty continue to be debated, especially given that skeletal maturity is reached at different ages for female and male children, but our selected age thresholds are well-established in the literature and provide reasonable subgroups for analysis and discussion. [6][7][8] Allogenic cartilage grafts are not captured by this dataset as these are not coded as separate surgical procedures like autogenic cartilage graft harvest. In addition, it is not possible to decipher whether patients undergoing primary cleft rhinoplasty were previously treated with nasoalveolar molding, as this could potentially impact the surgical correction.…”

Section: Discussionmentioning

confidence: 99%

“…Despite querying for specific procedure codes for cleft rhinoplasty, it is impossible to rule out whether some surgeons performing cleft rhinoplasty procedures utilized standard rhinoplasty codes. Age cutoffs for appropriate timing of primary, intermediate, and late cleft rhinoplasty continue to be debated, especially given that skeletal maturity is reached at different ages for female and male children, but our selected age thresholds are well-established in the literature and provide reasonable subgroups for analysis and discussion 6–8. Allogenic cartilage grafts are not captured by this dataset as these are not coded as separate surgical procedures like autogenic cartilage graft harvest.…”

Section: Discussionmentioning

confidence: 99%

“…Primary cleft rhinoplasty was defined as age 0 to 4 years, intermediate cleft rhinoplasty was defined as age 4 to 12 years, and late cleft rhinoplasty after midface skeletal maturity was defined as age 12 to 18 years. [6][7][8] Tip rhinoplasties were defined as CPT 30460, whereas rhinoplasties with septoplasty and/or osteotomies were defined as CPT 30462. Ear cartilage grafts were defined as CPT 21235, whereas rib cartilage grafts were defined as CPT 21230 and 20910.…”

Section: Methodsmentioning

confidence: 99%

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Cleft Rhinoplasty: Does Timing and Utilization of Cartilage Grafts Affect Perioperative Outcomes?

Kalmar

Carlson

Patel

et al. 2022

Journal of Craniofacial Surgery

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Background: The purpose of this study was to evaluate the epidemiology and perioperative complications of different reconstructive strategies to correct cleft nasal deformity, with particular attention paid to type and timing of cartilage grafting. Methods: Retrospective cohort study was conducted of cleft rhinoplasty performed between 2012 and 2017 in North America utilizing the American College of Surgeons National Surgical Quality Improvement Program- Pediatric hospital network. Medical/surgical complications, reoperations, and readmissions within 30 days postoperatively were analyzed with appropriate statistics. Results: During the study interval, 3317 pediatric patients underwent cleft rhinoplasty, with 8.0% involving the use of cartilage grafts. Ear cartilage was significantly more commonly used for intermediate repair, whereas rib cartilage was more commonly used for late repair (P=0.006). Overall, rhinoplasties with ear cartilage grafts had shorter procedure durations than those without cartilage grafts (P=0.005), whereas those with rib cartilage grafts had increased procedure duration (P<0.001). The use of cartilage grafts was not associated with increased complications in either intermediate or late cleft rhinoplasty. Patients with bilateral clefts were more likely to undergo rhinoplasty with cartilage grafts overall (P=0.047) and with cartilage grafts for late reconstruction (P=0.039). Conclusions: Ear cartilage is most frequently utilized for intermediate repair, whereas rib cartilage is most frequently utilized for late repair during cleft rhinoplasty. Ear cartilage grafts are associated with significantly decreased procedure duration, whereas rib cartilage grafts are associated with significantly increased procedure duration. Not surprisingly, cleft rhinoplasty is relatively safe, with a 2% overall short-term complication rate.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%