Adverse Outcomes and Complications of Autologous Versus Homologous Costal Cartilage Grafts in Septorhinoplasty: A Systematic Review and Meta-analysis

Abstract

Costal cartilage is frequently used in rhinoplasty when septal cartilage is insufficient; however, comparative data across different processing methods remain limited. This systematic review and meta-analysis evaluated complication rates associated with autologous costal cartilage (ACC), irradiated homologous costal cartilage (IHCC), Tutoplast-processed cartilage, and fresh-frozen costal cartilage grafts. Following the PRISMA guidelines, 50 studies comprising 4,482 patients were included (ACC, n = 1,951; Tutoplast, n = 1,200; IHCC, n = 676; fresh frozen, n = 629). Random-effects meta-analysis demonstrated low pooled complication rates: warping (2.9%), resorption (1.6%), infection (1.9%), extrusion (0.0%), revision surgery (5.0%), and patient dissatisfaction (4.0%). No significant differences were observed among graft types for any outcome (all P > .05), suggesting comparable safety profiles. Configuration and processing influenced specific outcomes. For ACC dorsal onlay grafts, laminated constructs showed significantly lower warping rates than en bloc grafts (0.0% vs 5.42%; P = .004). Among en bloc dorsal grafts across all types, fresh-frozen cartilage demonstrated the lowest warping rate (0.60%), significantly lower than ACC (P = .030). Risk of bias, assessed using the ROBINS-I tool, was serious to critical across studies, with evidence of small-study effects. Given the predominance of retrospective designs and substantial heterogeneity, findings should be interpreted cautiously. Graft selection may therefore be guided by availability, cost, and surgeon experience rather than differences in complication rates alone. Prospective, standardized studies with long-term follow-up are warranted.