Commentary on: "Outcomes of Autologous Versus Irradiated Homologous Costal Cartilage Grafts in Rhinoplasty" by Virginia E. Drake et al.

In this commentary, I discuss Drake et al.'s manuscript, "Outcomes of Autologous versus Irradiated Homologous Costal Cartilage Grafts in Rhinoplasty"1 and its greater implications for cartilage selection for grafting in septorhinoplasty. The authors provide a robust institutional example of the similarities shared between both autologous costal cartilage and irradiated homologous costal cartilage in terms of warping, infection, resorption, and overall result possible. This study adds to the current body of literature regarding this topic and helps surgeons make better, evidence-based decisions regarding cartilage grafting for their rhinoplasty patients.

Evaluation of Postoperative Infection Rates in 3084 Rhinoplasty Cases Using Antibiotic Soaks and/or Irrigations.

Background: Postoperative infections after rhinoplasties are rare, yet devastating on patient outcomes. The literature reports an overall incidence of <2% with higher numbers seen in those requiring revision procedures. Materials and Methods: A retrospective chart review of rhinoplasty patients from 2002 to 2019 of the primary author (D.M.T.) was performed. The objective of this study is to demonstrate the use of postoperative antibiotic soaks and irrigations in rhinoplasty, as well as evaluate the postoperative infection rates. Results: Of the 3084 rhinoplasty procedures evaluated, there were 19 postoperative infections (infection rate [IR] = 0.62%). Patients without antibiotic soaks or irrigations had 17 infections (IR = 1.01%). The IR of antibiotic soaks was 0.08% with a significant reduction compared with no soaks/irrigations (p = 0.0053). With antibiotic soaks and irrigations, there was 1 infection (IR = 0.49%) with no significant difference between no soaks/irrigations or soaks alone. Conclusions: The use of antibiotic soaks and irrigations resulted in an IR of 0.62%. Antibiotic soaks reduced the rate of postoperative infection, particularly in secondary rhinoplasty. Antibiotic soaks and irrigations are safe, effective, and well-tolerated by patients. As a result, these techniques may be considered in patients undergoing rhinoplasty, particularly those with an extensive revision history, trauma, filler, prior infection, or underlying disease processes.

Cost-effectiveness of sialendoscopy versus medical management for radioiodine-induced sialadenitis.

OBJECTIVES/HYPOTHESIS: The medical management and radiographic identification of radioiodine-induced sialadenitis (RAIS) is challenging. This study utilizes a cost-effectiveness analysis to compare upfront sialendoscopy as both a diagnostic and therapeutic option versus multiple modalities of diagnostic radiography along with medical management. STUDY DESIGN: Literature review and cost-effectiveness analysis. METHODS: A literature review was performed to identify the outcomes of medical management, sialendoscopy, diagnostic radiography, and surgical complications. All charges were obtained from the University of Mississippi Budget Office in 2017 US dollars and converted to costs using the 2017 Medicare Cost-to-Charge Ratio for urban medical centers. A cost-effectiveness analysis was used to evaluate the four treatment arms-sialendoscopy, medical management- ultrasound, medical management-computed tomography (CT) sialography, and medical management-magnetic resonance (MR) sialography. Sensitivity analyses were used to evaluate the confidence levels of the economic evaluation. RESULTS: The incremental cost-effectiveness ratio for upfront sialendoscopy versus medical management-ultrasound was $30,402.30, which demonstrates that sialendoscopy is the more cost-effective option given a willingness-to-pay threshold of $50,000. The probability that this decision is correct at a willingness-to-pay of $50,000 is 64.5%. Sialendoscopic improvement was the most sensitive variable requiring a threshold of 0.70. Of the three imaging modalities, ultrasound dominated MR and CT sialography, both of which required a willingness-to-pay of greater than $90,000 to realize a difference. CONCLUSIONS: Upfront sialendoscopy is more cost-effective compared to medical management utilizing diagnostic ultrasound assuming a willingness-to-pay threshold of $50,000. There is a clear cost-effectiveness to using ultrasound with medical management over CT and MR sialography in the diagnosis and management of RAIS. LEVEL OF EVIDENCE: NA. Laryngoscope, 1822-1828, 2018.