The use of autologous and cadaveric cartilage grafts in rhinoplasty: an Australian survey study

Background: Rhinoplasty is regarded as one of the most complex procedures in facial plastic surgery. The need for structural support in rhinoplasty often necessitates the use of extra-nasal cartilage grafts, particularly in cases of previous surgery or trauma. This study investigates the current practices and preferences regarding the use of autologous rib graft (ARG) and cadaveric rib graft (CRG) among Australian facial plastic surgeons. Methods: An 18-question survey was distributed to members of the Australasian Academy of Facial Plastic Surgery (AAFPS) between May and June 2024. The survey assessed the usage patterns, preferences, and experiences related to ARG and CRG in rhinoplasty. Responses were analyzed using multivariate logistic regression to identify predictive factors influencing CRG usage. Results: Out of 90 active AAFPS members, 39 completed the survey (43.3% response rate). Most respondents (64.1%) performed over 50 rhinoplasties annually, with a high prevalence of CRG use (95%) compared to ARG (79.5%). The primary reasons for preferring CRG included reduced donor site morbidity and shorter procedure times. Patient concerns, CRG availability and cost, were noted as limiting factors for CRG usage, whilst concern for CRG related complications was low. Multivariate analysis revealed that performing more than 50 rhinoplasties per year significantly predicted regular CRG use [odds ratio (OR) =10.58, P=0.03, 95% confidence interval (CI): 1.4–64.8]. Conclusions: The majority of Australian facial plastic surgeons surveyed were experienced with CRG in rhinoplasty, and particularly utilized CRG for structural grafting. Performing more than 50 rhinoplasties per year was a significant predictor of frequent CRG usage. It is likely that the increased use of CRG among high-volume surgeons (>50 rhinoplasties annually) is due to a combination of factors, including a preference for more advanced reconstructive techniques and a higher proportion of revision cases, both of which typically necessitate extra-nasal cartilage sources. This study provides valuable insights into the current practices of facial plastic surgeons in Australia, contributing to the broader understanding of graft utilization in rhinoplasty. There remains the need for ongoing research into the long-term performance of both ARG and CRG.