Clinical Efficiency And Viability Of Cadaveric Allograft In Aesthetic And Reconstructive Rhinoplasty
Chitang J. Joshi, MD, Rou Wan, MD, Miguel Carabano, MD, Abbas Hassan, MD, Jing Liu, MD, MA, Robert D. Galiano, MD, FACS.
Northwestern University, Chicago, IL, USA.
PURPOSE: Nasal shape and symmetry are much sought aesthetically and functionally, and any abnormality or asymmetry leads not only to cosmetic, but psychological, functional and physiological concerns. Primary or recurrent rhinoplasty aims at correcting asymmetry or abnormality, in most cases requiring cartilage grafts to provide for support and maintain shape. Autologous Cartilage has been at the forefront for years, but require harvesting and increase pain and duration of the procedure. Allograft Cartilage provides a valid alternative in nose job surgeries.
METHODS: This is a single‐center, blinded, controlled trial, conducted in healthy adult subjects undergoing a reconstructive or cosmetic rhinoplasty involving the use of cartilaginous graft. This study will evaluate the outcomes and utility of allograft cartilage compared to autologous cartilage. 30 subjects will be recruited. Eligible consenting patients will be grouped into their respective cohorts. They receive either autologous or cadaveric graft. Prior to surgery, the patients fill out the pre‐operative sections of a Face‐Q checklist and will have pictures taken for documentation and comparison. Subjects have 1 week, 6 weeks, 12 weeks, 6 months, and 1‐ year clinical follow-up, which will include, patients completing the corresponding sections of the Face-Q standardized 2D and 3D photographs. Adverse events would be recorded throughout the 1‐year study period.
RESULTS: 22 patients have been recruited so far and are involved in different stages of follow up, categorized into the following groups (Allograft vs. Control). Both cohorts show no difference in the pre‐operative Face‐Q checklist (p-value >0.39). Week 1, Week 6 and Week 12 follow up to show no statistical significance (p‐value >0.56, >0.5, >0.42 respectively). Scores for all patients at 6 months and 1-year is needed to confirm comparable or non- superiority of the allograft cartilage. Analysis using photometric analysis of pre-operative and 3 months, 6 months and 1-year post-operative pictures reveals correction and clinical viability of the allograft without complications like resorption, warping, etc.
CONCLUSION: Non-superiority of allograft cartilage provides a viable and easy-to‐use off-the-shelf alternative to harvesting of autologous cartilage. This advantage, coupled with comparable clinical and aesthetic outcomes prevents a second incision to harvest cartilage, which may cause pain and increase procedural duration and cost. Long‐term follow up has shown good clinical utility without any complications like warping or resorption.
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