ALGORITHM FOR SELECTING AUTOLOGOUS CARTILAGE TRANSPLANT IN SECONDARY RHINOPLASTY

Abstract

Relevance: Secondary rhinoplasty is one of the most complex and technically demanding procedures in nasal reconstructive surgery. Traditionally, the choice of the type of autologous cartilage graft is based on the surgeon's subjective assessment of anatomical structures. However, modern studies demonstrate significant advantages of using objective research methods for planning complex reconstructive interventions such as radiological methods, including CT. Therefore, preoperative assessment of the state of the residual cartilage support of the nose becomes relevant in the context of planning the scope of the reconstructive intervention and choosing the optimal donor material.

Objective: To develop an objective algorithm for choosing the type of autologous cartilage graft for secondary rhinoplasty based on radiological and clinical data.

Materials and methods: The prospective study included 54 patients aged 18 to 60 years who underwent secondary rhinoplasty using autologous cartilage grafts between January 2022 and January 2025. All patients underwent preoperative multispiral CT of the nasal septum. Based on the obtained CT data in combination with clinical assessment of the condition of the nasal septum, upper lateral nasal cartilages and greater alar cartilages and the nasal bony pyramid, a cartilage support score developed by us was calculated on a scale from 0 to 9 points.

Results: The mean age of the subjects was 37.5 years with a range from 22 to 52 years, and women accounted for 81.5% of the sample. Costal cartilage was used in 37 patients (68.5%), septal cartilage in 9 patients (16.7%), and auricular cartilage in 8 patients (14.8%). The distribution of patients according to the level of cartilage support was clinically significant. Critical loss of support, corresponding to scores from 0 to 2, was observed in 5 patients (9.3%), which corresponded to the most severe cases with multiple previous interventions. Moderate support with scores from 3 to 5 was diagnosed in 37 patients (68.5%), and adequate support with scores from 6 to 9 was maintained in only 12 patients (22.2%).

Conclusions: The nasal cartilage support score is the most informative prognostic factor for the choice of cartilage graft type with an importance of 0.68 in the decision tree model, with patients with a support score below 3 requiring the mandatory use of costal cartilage, while with a score above 7 even fragments of septal cartilage can be used if available. Despite the statistically significant difference in cartilage support score between groups, all three types of autologous cartilage grafts provide satisfactory functional and aesthetic results twelve months after surgery.