Outcomes of Cadaveric Allograft versus Autologous Cartilage Graft in Functional Septorhinoplasty

Saadi, Robert; Loloi, Justin; Schaefer, Eric; Lighthall, Jessyka G.

doi:10.1177/0194599819866812

Cited by 14 publications

(17 citation statements)

References 43 publications

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“…However, more recent studies and meta-analyses demonstrate that there is no difference in extrusion, infection, and resorption rates between autologous and irradiated homologous costal cartilage. 14,15 Finally, given the psychological burden of ENS, 16 we administered the GAD-7 and PHQ-9 questionnaires to assess patients' anxiety and depression symptoms. While both GAD-7 and PHQ-9 scores were reduced at all postoperative time points, these results were not statistically significant.…”

Section: Discussionmentioning

confidence: 99%

Long‐Term Outcomes of Inferior Meatus Augmentation Procedure to Treat Empty Nose Syndrome

et al. 2021

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Objectives/Hypothesis: We sought to report the long-term, symptom-focused, prospective outcomes in empty nose syndrome (ENS) patients after undergoing inferior meatus augmentation procedure (IMAP) through use of four validated questionnaires: Empty Nose Syndrome 6-Item Questionnaire (ENS6Q), 22-item Sino-Nasal Outcome Test (SNOT-22), Generalized Anxiety Disorder 7-Item Scale (GAD-7), and Patient Health Questionnaire-9 (PHQ-9).Study Design: Prospective case series.Methods: A single-center prospective case series was performed for patients diagnosed with ENS who underwent IMAP between July 2017 and February 2020. Diagnosis of ENS was based on the following criteria: 1) reported discomfort with nasal breathing and/or paradoxical nasal obstruction after inferior turbinate reduction, 2) a positive ENS6Q score of at least 11, and 3) a positive cotton test. Questionnaire responses were recorded prior to surgery as well as 1, 3, 6, and 12 months postoperatively.Results: Seventeen eligible patients were included. Mean ENS6Q scores were significantly reduced at all postoperative time points (p < .0001, p < .0001, p < .0001, p = .0003). Of the six ENS6Q subdomains, five (suffocation, dryness, sense of diminished airflow, nasal crusting, and nasal burning) were significantly reduced 1-year postoperatively (p < .0001, p = .0004, p = .0136, p = .0114, p = .0080, respectively). SNOT-22 scores were significantly reduced at all time points (p = .0021, p = .0227, p = .0004, and p = .0025). Of the SNOT-22 subdomains, the sleep subdomain was significantly reduced 1-year postoperatively (p = .0432). Low baseline GAD-7 and PHQ-9 scores were recorded at 7 and 9.4, respectively, and although scores at all postoperative time points were reduced, there was no statistical significance.Conclusion: IMAP via implant of cadaveric rib cartilage provides significant, long-term improvements in ENS-specific and general sinonasal symptoms.

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Section: Discussionmentioning

confidence: 99%

Long‐Term Outcomes of Inferior Meatus Augmentation Procedure to Treat Empty Nose Syndrome

et al. 2021

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“…There have been many previous publications examining the rates of complications including infection, resorption, and warping for both CCA and HCA. 1,2,4,5 However, published rates vary widely and there remains no consensus as to which is the more reliable graft option. Variability in complication rates has been attributed to reporting and publication bias, inconsistent definitions, low level of evidence, and surgeon technique.…”

Section: Discussionmentioning

confidence: 99%

“…Variability in complication rates has been attributed to reporting and publication bias, inconsistent definitions, low level of evidence, and surgeon technique. 2,22,25 Inherent differences in HCA graft preparation have even been cited as a contributing factor with grafts undergoing chemical processing prior to irradiation demonstrating a much higher rate of resorption of 31% as compared 0.53% for those without chemical processing. 28 A recent meta-analysis comparing complication rates between CCA and HCA found no significant differences in rates of warping, resorption, infection, contour irregularity, or need for revision surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The risks and benefits of both of these grafting materials have been heavily debated in the literature. [1][2][3] CCA carries the risks of donor site pain and morbidity, hypertrophic chest scarring at the donor site, a low but real risk of pneumothorax, and rates of warping cited between 0% and 25%. In addition, there is additional time required in the operating room for the harvesting of costal cartilage.…”

Section: Introductionmentioning

confidence: 99%

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Cost Utility Analysis of Costal Cartilage Autografts and Human Cadaveric Allografts in Rhinoplasty

Starr

Creel

Harryman

et al. 2021

Ann Otol Rhinol Laryngol

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Background: Human cadaveric allograft (HCA) and costal cartilage autograft (CCA) have been described for reconstruction during rhinoplasty. Neither are ideal due to infection, resorption, and donor site morbidity. The clear superiority of 1 graft over the other has not yet been demonstrated. This study assesses comparative costs associated with current grafting materials to better explore the cost ceiling for a theoretical tissue engineered implant. Materials and methods: A cost utility analysis was performed. Initial procedure costs include physician fees (CPT 30420), hospital outpatient prospective payments, ambulatory surgical center payments, and fees for the following: rib graft (CPT 20910), hospital observation, and DRG (155) for inpatient admission. Additional costs for revision procedure, included the following fees: physician (CPT 30345), rib graft, hospital outpatient prospective payment, and ambulatory surgical center payments. Total costs under each scenario were calculated with and without the revision procedure. Comparison of total costs for each potential outcome to the estimated health utility value allowed for comparison across rhinoplasty subgroups. Results: The mean cost of primary outpatient rhinoplasty using HCA and CCA were $8075 and $8342 respectively. Revision outpatient rhinoplasty averaged $7447 and increased to $8228 if costal cartilage harvest was required. Hospital admission increased the cost of primary rhinoplasty with CCA to $8609 for observational admission and to $13653 for 1 day inpatient admission. Revision CCA rhinoplasty with an inpatient admission complicated by pneumothorax increased costs to $21 099. Conclusion: Cost of rhinoplasty without hospitalization was similar between HCA and CCA and this cost represents the lower limit of a practical cost for an engineered graft. Considering complications such as need for revision or for admission after CCA due to surgical morbidity, the upper limit of cost for an engineered implant would approximately double.

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“…Its extracellular matrix contains col-lagen IIAI (COL2A1) type, aggrecan, decorin, and biglycan [25]. In clinical procedures, sometimes it is used for the autologous ear reconstruction [26,27], mentoplasty [28] and rhinotherapy [29,30] and in cadaveric allografts [31].…”

Section: Introductionmentioning

confidence: 99%

Concentrations of volatile substances in costal cartilage in relation to blood and urine – preliminary studies

Tomsia¹,

Nowicka²,

Skowronek³

et al. 2021

amsik

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Aim:The study aimed to examine whether volatile substances (ethanol, isopropanol, and acetone) can be detected in costal cartilage and also if concentrations of detected substances reliably reflect their concentrations in the peripheral blood -the standard forensic material for toxicological analyses. Such knowledge can be useful in cases when a cadaver's blood is unavailable or contaminated. Material and methods: Ethanol, isopropanol, and acetone concentrations were determined in samples of unground costal cartilage (UCC), ground costal cartilage (GCC), femoral venous blood, and urine. The samples were analysed by gas chromatography (GC) with a flame ionization detector using headspace analysis. Results: Volatile substances were detected in 12 out of 100 analysed samples. There was a strong positive correlation between ethanol concentration in the blood and urine (r = 0.899, p < 0.001), UCC (r = 0.809, p < 0.01), and GCC (r = 0.749, p < 0.01). A similar strong correlation was found for isopropanol concentration in the blood and urine (r = 0.979, p < 0.001), UCC (r = 0.866, p < 0.001), and GCC (r = 0.942, p < 0.001). Acetone concentration in the blood strongly correlated only with its concentration in urine (r = 0.960, p < 0.001). Conclusions: We demonstrated for the first time the possibility of detecting volatile substances: ethanol, isopropanol and acetone in a human costal cartilage. Also, the study showed that higher volatiles concentrations were better determined in ground samples.

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Outcomes of Cadaveric Allograft versus Autologous Cartilage Graft in Functional Septorhinoplasty

Cited by 14 publications

References 43 publications

Long‐Term Outcomes of Inferior Meatus Augmentation Procedure to Treat Empty Nose Syndrome

Long‐Term Outcomes of Inferior Meatus Augmentation Procedure to Treat Empty Nose Syndrome

Cost Utility Analysis of Costal Cartilage Autografts and Human Cadaveric Allografts in Rhinoplasty

Concentrations of volatile substances in costal cartilage in relation to blood and urine – preliminary studies

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