Many nasal deformities require some form of graft or implant material for complete correction. Various well-rec-ognized disadvantages are associated with currently used autografts, allografts, and alloplastic materials, thereby maintaining a continued search for the ideal nasal graft. Irradiated homograft costal cartilage is an allograft that has been used with variable success in the head and neck region. Isolated reports have suggested favorable results with irradiated homograft costal cartilage implantation in the nose. This study details the findings of 306 irradiated homograft costal cartilage grafts that were used in 122 nasal augmentation procedures.
(Arch Otolaryngol Head Neck Surg. 1993;1 19:24-31)
Autogenous cartilage is widely considered the ideal grafting material for nasal surgery.1,2 Septal cartilage is usually preferred, followed by auricular cartilage and costal cartilage. Excellent tissue tolerance and graft longevity result from the perfect biocompatibility that exists between autogenous cartilage and the host’s recipient tissue bed.3 Additionally, autogenous cartilage is easy to contour and resists infection. However, limited donor material, donor site morbidity, variable resorption rates, and increased operative time restrict the use of autogenous cartilage in many cases.
Various alloplastic materials have been used for augmentation in cosmetic and reconstructive nasal surgery. Unfortunately, most alloplastic substances act as foreign bodies and are not biologically incorporated into surrounding tissues. This can result in an increased risk of infection, mobility, or extrusion.
Heterografts and homografts provide other options for nasal augmentation. Glutaraldehyde-processed, irradiated bovine cartilage grafts have been used for nasal reconstruction4; however, the inherent tissue bioincompatibility that exists between humans and other species may predispose this material to eventual resorption. Demineralized bone is an allograft that induces the conversion of mesenchymal cells into osteoblasts, with variable degrees of bone production.5 Although it has demonstrated success in filling craniofacial defects,6 demineralized bone has an unacceptably high resorption rate when used in nasal surgery.
Irradiated homograft costal cartilage (IHCC) represents another graft option for use in the head and neck. This allograft is procured from donors who are screened for any systemic or local infectious process, metastatic cancer, and intravenous drug abuse. The cartilage blocks are stored in a saline solution and then exposed to 30 000 to 40,000 Gy of gamma irradiation using a cobalt 60 source. Irradiated homograft costal cartilage is readily available, conveniently stored, easily carved, and relatively inexpensive. External incisions for graft harvesting and other potential donor site morbidities are eliminated with the use of IHCC. It is a structurally sound material that can provide support and volume in nasal surgery. Other advantages include its resistance to infection, extrusion, and warping. As a graft, IHCC displays excellent tissue tolerance, which is probably attributable to the low antigenicity characteristic of cartilage in general. The irradiation process may enhance tissue tolerance beyond that of fresh allograft cartilage by further reducing its already low antigenic load. 7
Several clinical studies8-11 have evaluated the effectiveness of IHCC as a graft in the head and neck region; however, these investigations did not specifically focus on its use in the nose. This point deserves emphasis because long-term resorption rates and contour preservation may vary between implantation sites.12 This study is a preliminary report on the efficacy of IHCC as a graft material for nasal augmentation and reconstruction.
