Preservation of septal cartilage for early revisions: a histopathological study

Objective: To determine how storage medium and temperature affect the histological viability of autologous septal cartilage intended for early revision rhinoplasty. Methods: Cartilage specimens stored for 6 and 12 months in four media—dry, gentamicin, cefazolin, and saline—at two distinct temperatures underwent histopathological evaluation after paraffin embedding. The assessed parameters were graft viability, fibrosis, osteoid metaplasia, and peripheral chondroid proliferation. Results: Among 480 septal cartilage specimens harvested from 30 patients, overall viability fell from 62 ± 15% at 6 months to 44 ± 14% at 12 months (p < 0.001), while fibrosis, osteoid metaplasia, and peripheral chondroid proliferation all increased significantly (each p < 0.001). Viability declined in every storage condition, but grafts kept at − 80 °C or in saline-based solutions deteriorated fastest, reaching a mean viability of 39% versus 53% for dry storage at − 20 °C at 12 months. Multivariate analysis confirmed − 80 °C storage (OR 2.3, 95% CI 1.4–3.8) and saline media (OR 1.9, 1.1–3.4) as independent predictors of poor viability (< 40%), whereas antibiotic additives were not protective. Histological evidence of osteoid metaplasia (OR 3.6, 1.9–6.8) and peripheral chondroid proliferation (OR 2.1, 1.2–3.7) strongly predicted non-viable grafts. A linear mixed-effects model demonstrated additive negative effects of − 80 °C and saline on both baseline viability and its rate of decline (marginal R² = 0.52). Dry storage at − 20 °C yielded the most favorable long-term viability. Conclusion: Dry storage of autologous septal cartilage at − 20 °C preserves graft viability well enough to offer a cost-effective alternative for early revision surgeries, warranting confirmation in prospective clinical trials.