Use of auricular versus costal cartilaginous grafts for secondary rhinoplasty procedures: comparison of long-term outcomes

Background: Secondary rhinoplasty is a much more complex operation than primary rhinoplasty, because previously operated and fibrotic tissue is involved. The predictability of results, both aesthetic and functional, is thus inherently lower, demanding greater attention and safety. Even more intricate are those instances in which cartilaginous septum is absent, either in part or almost entirely. This comparative analysis targeted long-term outcomes of secondary rhinoseptoplasties using either auricular or rib cartilage as grafts. Methods: All patients selected for study met the following criteria: (a) required secondary rhinoplasty for functional and/or cosmetic problems, (b) voids of septal cartilage, (c) follow-up of ~ 2 years, (d) availability of standard pre- and postoperative photos, (e) fair command of the Italian language, and (f) signed participatory consent. Each subject was randomly assigned to group 1 (costal cartilage graft for secondary rhinoplasty) or group 2 (auricular cartilage graft for secondary rhinoplasty). In follow-up, patients completed the Italian version of the FACE-Q rhinoplasty module. Anthropometric measurements were also acquired in AutoCAD for MAC. We determined angles of deviation pre- and postoperatively for comparison and analysed patient satisfaction levels by group using the chi-squared test for unpaired data. Two plastic surgeons reviewed all postoperative photographs of study subjects, rating them on a scale of 1–5. Results: A total of 135 patients undergoing primary rhinoplasties between January 2008 and September 2019 in our Department of Plastic Surgery and meeting all inclusion criteria qualified for study. Mean patient age was 48.5 years, and mean follow-up time was 3 years. Pre- and postoperative FACE-Q values in group 1 differed significantly (p < 0.05). Anthropometric measurements revealed significant differences (p < 0.05) in pre- and postoperative angles of septal deviation determined for group 1 vs group 2. In long-term follow-up, group 1 maintained an angle close to 180° (p < 0.015), and results in group 1 (vs group 2) remained stable (p < 0.05). Members of group 2 underwent more secondary procedures by comparison (p < 0.05). Ultimately, the two reviewers determined that outcomes in group 1 (vs group 2) proved more satisfactory (p < 0.05). Conclusions: This effort is the first to compare grafting of auricular and costal cartilage in secondary rhinoplasty procedures. Implants from the 5th rib are preferential to ensure satisfactory long-term outcomes and durable, natural aesthetics in patients lacking septal cartilage. Level of evidence: Level V, Therapeutic.