Abstract

Relevance: Secondary rhinoplasty represents a complex surgical challenge due to scar tissue formation, disruption of anatomical landmarks, and donor material deficiency following previous interventions. The selection of optimal autologous cartilage graft type for nasal structural support restoration remains a subject of scientific debate and requires clear stratification based on deformity characteristics.

Objective: To analyze the frequency of different autologous cartilage graft types usage in secondary rhinoplasty, to assess the frequency and nature of postoperative complications, and to evaluate surgical treatment outcomes depending on the cartilage type used and deformity characteristics.

Materials and Methods: A retrospective analysis of 73 secondary rhinoplasty cases using autologous cartilage grafts was conducted from February 2019 to December 2023. Patient demographics, surgical history, deformity type and characteristics, intraoperative parameters, postoperative complications, and treatment outcomes were analyzed. Statistical analysis was performed using Python 3.11 with Mann-Whitney U-test, Kruskal-Wallis test, Fisher’s exact test, and Spearman correlation coefficient.

Results: The mean patient age was 32.4±8.7 years, with female predominance (80.8%). Costal cartilage was used most frequently (63% of cases), particularly in complex deformities. Open transcolumellar approach was employed in 90.4% of cases. Overall complication rate was 8.2%, with graft resorption (4.1%) and hematoma formation (2.7%) being most common. Significant risk factors for complications were identified: smoking increased complication rates from 2.2% to 22.2% (p=0.01), multiple previous surgeries elevated risk from 2.3% to 20.7% (p=0.006). Functional improvement in nasal breathing was achieved in 84.9% of patients, with aesthetic satisfaction in 91.8%.

Conclusions: The study demonstrates the necessity of individualized approach to autologous cartilage graft selection in secondary rhinoplasty. Costal cartilage remains the optimal choice for complex reconstructions, while septal and auricular cartilage are appropriate for smaller-volume deformities. Smoking, multiple previous surgeries, autoimmune diseases, and operative duration are key risk factors requiring careful preoperative assessment and modification.

Keywords: secondary rhinoplasty, autologous cartilage grafts, costal cartilage, nasal septum, nasal cavity, nasal deformity, nasal breathing, rhinoplasty complications, nasal surgical reconstruction, nose.