A systematic review and meta-analysis of complications associated with crushed cartilage in rhinoplasty

Abstract

BackgroundCrushed cartilage grafts improve augmentation and contour irregularities in rhinoplasty; however, they are associated with complications including resorption, asymmetries, palpability, and need for revisionary surgery. MethodsA systematic review and meta-analysis using PRISMA guidelines was performed of all recorded history to November 2022 using the search query ("crush" or "crushed") AND cartilage AND rhinoplasty for the PubMed, World of Science, Embase, and Cochrane online registries. Data was collected on study information, patient demographics, surgical details and outcomes. Graft resorption and revision surgery were pooled in a random-effects model, and a subgroup analysis for different coverage of the cartilage and degree of crushing. ResultsThe initial search yielded 163 results with 11 studies included in final full text review. A total of 1,132 patients were analyzed with 456 (40.3%) females, mean age 48.0, and average follow-up of 24.9 months. Cartilage resorption rates were statistically higher in graft preparation with severe crushing (3.4%) compared to non-severe crushed (0.9%) (p=0.049). There was no significant difference in resorption rate for patients with covered cartilage graft (1.3%) compared to non-covered grafts (1.8%) (p=0.7). There were significantly more revision surgeries for severely crushed (17.9%) compared to non-severely crushed cartilage (3.5%) (p=0.003). ConclusionsSevere crushed cartilage grafting provides smooth contour and less palpability compared to other degrees of crushing but demonstrates significantly higher rate of resorption.