A Systematic Review and Meta-Analysis of Autologous vs Irradiated Homologous Costal Cartilage Grafts for Dorsal Augmentation Rhinoplasty

Autologous costal cartilage (ACC) is commonly used for dorsal augmentation rhinoplasty because of its availability and strength, despite risks such as hypertrophic scarring and pneumothorax for the patient. Irradiated homologous costal cartilage (IHCC) offers an alternative, potentially mitigating these complications. Previous reviews comparing these materials have been methodologically weak. The aim of this study is to perform a robust systematic review and meta-analysis comparing the outcomes of ACC and IHCC in dorsal augmentation rhinoplasty to guide clinical decision making in nasal reconstruction. Medline, Embase, Google Scholar, and the Cochrane Central Register of Controlled Trials databases were searched. Data extraction and quality assessment were performed by 2 independent authors. The primary outcomes of interest were warping, revision rates, infection rates, and displacement. Methodological quality and risk of bias were assessed using Grading of Recommendations Assessment, Development, and Evaluation and Cochrane's ROBINS I tool, respectively. Thirty-six articles were reviewed, including 1 comparative and 35 single-arm studies (ACC: 29, IHCC: 8), encompassing 2526 patients from 13 countries. Adverse events included warping (ACC: 6%, P < .0001; IHCC: 6%, P < .0001). Resorption rates were 1% for ACC (P = .06) and 3% for IHCC (P < .0001). Revision surgery rates were similar (ACC: 4%, P < .001; IHCC: 4%, P < .001), as were infection rates (ACC: 1.8%, P = .03; IHCC: 1.3%, P = .03). Current evidence does not demonstrate the superiority of ACC or IHCC for dorsal augmentation rhinoplasty. Both grafts are viable, with the choice guided by patient and surgeon preferences. Prospective, high-quality data with standardized outcomes are needed to improve clinical decision making.