The epidemiology of autologous tissue grafting in primary and revision rhinoplasty
Linda N. Lee MD  Olivia Quatela BS  Neil Bhattacharyya MD, FACS
First published: 08 November 2018 https://doi.org/10.1002/lary.27551
This work was performed at the Massachusetts Eye and Ear Infirmary (l.n.l., o.q.) and Brigham and Women's Hospital (n.b.), Boston, Massachusetts, U.S.A.
n.b. is a consultant for IntersectENT, Inc. and Entellus, Inc.
The authors have no other funding, financial relationships, or conflicts of interest to disclose.
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Abstract
Objectives/Hypothesis
To determine the percentage of primary versus revision rhinoplasty cases that require an extranasal source of grafting, as well as age and gender‐specific trends.

Study Design
Cross‐sectional analysis of multistate ambulatory surgery and hospital databases.

Methods
Ambulatory rhinoplasty procedures were extracted from the State Ambulatory Surgery Databases for New York, Kentucky, North Carolina, Michigan, and Florida for 2014 to 2015. Cases were examined for simultaneous use of extranasal grafts.

Results
A total of 8,510 rhinoplasties were extracted (65.3% female, mean age = 35.6 years), and 11.9% were revision cases (95% confidence interval [CI]: 11.2‐12.6). An extranasal, autologous source of grafting was required in 12.7% of cases (5.3% auricular, 95% CI: 4%‐6.6%; 1.8% costal, 95% CI: 1%‐2.6%). Revision cases were more likely to require a secondary source of grafting (24.4%, 95% CI: 21.8%‐27.1% vs. 11.1%, 95% CI: 10.3%‐11.8%). In revision cases, the most common graft was auricular cartilage (14.4%, 95% CI: 12.2%‐16.6%) followed by costal (7.1%, 95% CI: 5.52%‐8.69%). Only 1.1% of primary cases required costal cartilage (95% CI: 0.88%‐1.36%) compared to 7.1% of revision cases (95% CI: 5.52%‐8.69%). Of the primary cases, 4.1% required auricular cartilage grafting (95% CI: 3.67%‐4.57%) compared to 14.4% of revision cases (95% CI: 12.2%‐16.6%). Patients who required a graft were older. Significantly more males required autologous grafting than females (P = .047).

Conclusions
Cartilaginous or bony grafting is a critical surgical technique in both primary and secondary rhinoplasties. This is the first study to examine percentages of site‐specific autologous grafting from auricular and costal donor sites for primary and revision cases. Gender and age‐specific trends associated with specific grafting sites are also identified. These data are important to help guide preoperative counseling and informed consent for all rhinoplasty surgeries.

Level of Evidence
NA

Laryngoscope, 129:1549–1553, 2019