Advances in autologous cartilage engineering for ear and nasal reconstruction: Current status and future prospects

The case of autologous cartilage engineering has revolutionized ear and nasal reconstruction. This event has resulted in an improved aesthetic and functional outcome in the surgical treatment of congenital, traumatic, and oncologic defects. As described in this review, the usage of tissue engineering treatments, which use autologous chondrocytes to alleviate immunogenicity and donor morbidity of traditional modalities such as rib graft cartilage or alloplastic implants, is of great importance. New technologies, such as 3D bioprinting and nanofibrous scaffolds, have made it possible to reproduce intricate auricular and nasal designs accurately, and bioinks such as nanofibrillated cellulose-alginate can be used to provide high-fidelity constructs. The microtia and nasal alar reconstruction with clinical translations are promising, and in the case of engineered cartilage, integration and minimal adverse outcomes were found in a 12-30-month follow-up. Nonetheless, issues that still exist are the long-term shape fidelity, biomechanical inferiority of the regenerating cartilage compared to that of the native cartilage and limited vascularisation in larger constructs. The problem of considerable prices and regulatory obstacles also hinders the mass use. The workarounds timely emerge in the form of emerging technologies, including dynamic, patient-specific structures with 4D bioprinting and machine learning optimized scaffold design. The directions of the future lie in prevascularized grafts, cost-effective biofabrication, and an increased variety of clinical trials to validate the long-term efficacy in various populations. Combining biomimetic scaffolds, powerful imaging technology, and a customised approach, autologous cartilage engineering exists to revolutionise reconstructive surgery, so long as the effort behind the continued research continues to solve the questions of enhanced scalability and regulatory hurdles. This review reviews the latest advances, critically assesses the limitations, and suggests ways of clinical translation to functional, long-lasting, and aesthetically better outcomes.