Diced Cartilage: An Effective Graft for Post-Traumatic and Revision Rhinoplasty

Abstract

Rhinoplasty has grown and developed over so many years but the choice of the graft material in revision rhinoplasty and rhinoplasty for post-traumatic cases still remains debatable. In such patients, non-availability of adequate autogenous graft, multiple septal fractures and skin fibrosis are a challenge to the rhinologist. To deal with this problem authors have used diced cartilage pieces as a grafting material. Secondary rhinoplasty for correction of the nasal dorsum was done in 32 patients and evaluated. The study, highlights the distinct advantages of using diced cartilage wrapped in fascia for dorsal augmentation. Full length grafts were used in all patients and this was supported on a L-shaped cartilage fixed between the two upper lateral cartilage. Fascial tube was prepared from fascia lata and conchal, rib or septal cartilage was the source of diced cartilage (0.5-1 mm sized pieces). The L-shaped structural support was prepared from the remnant of septal cartilage if any or from the conchal or rib cartilage. Patients were followed for a period of 6 months-3 years. In 30 patients post-op course was uneventful with good reconstruction results.Step-deformity was encountered in one patient and in another patient the tube opened with extrusion of diced cartilage pieces. Both these patients were effectively managed. In conclusion, diced cartilage wrapped in fascial tube has distinct advantages like it is simpler procedure and graft material is adequate and autogenous. Grafts can be prepared as per the desired length, shape and size to fit the specific defect. These being highly malleable can be used without any tension on the already thickened and fibrosed skin and soft tissue. Complications like step deformity and extrusion rarely occur and can be easily managed. Over correction and graft visibility were not met with.

Reconstruction Of Noe Fracture With Immediate Diced Costal Cartilage Grafting: A Case Series

“…Previous study used a "sleeve" to wrap these diced cartilage, either using fascia or Surgicel (Ethicon, Inc., Somerville, N.J.), we did not use any of these materials because it was more difficult to predict the amount of diced cartilage needed to filled the defect. It is easier to predict over-correction or undercorrection since the graft remains mobile for almost 2 -3 weeks 7,8 . Baser 6 In this procedure we choose to obtain and harvest rib cartilage instead of conchal or septal cartilage.…”

Dorsal Nasal Augmentation: Is the Composite Graft Consisting of Conchal Cartilage and Retroauricular Fascia an Effective Option?

“…These strategies helped provide a more predictable environment with adequate perfusion for graft viability. 5,27 Although many surgeons believe that overcorrection is necessary when using crushed cartilage, 28-32 the authors do not. Because of the unpredictable risk for graft resorption, they believe that overcorrection can cause hump formation.…”

“…A graduated *Assistant Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Qazvin University of Medical approach to reducing a dorsal hump is the easiest and most reliable method to provide a desirable profile; conversely, augmentation of a deficient dorsum is difficult. [2][3][4][5][6][7][8] Although different materials and techniques have been applied for this purpose, augmentation of a deficient nasal dorsum remains a challenge in rhinoplasty. Autologous grafts are widely used for dorsal augmentation.…”

“…10,11 Different methods, such as diced cartilage, diced cartilage wrapped in fascia, or diced cartilage covered with fascia, are used for dorsal augmentation. 5,[9][10][11][16][17][18][19] Concerns about the visibility of the graft edges and irregularities made by graft particles require surgeons to use different materials as cover. Superficial temporalis fascia, 20 fascia lata, 21 AlloDerm (LifeCell Corp, Branchburg, NJ), 9,22 and homologous material (Tutoplast; Davol, Warwick, RRI) 23 have been reported in the literature.…”

Advanced Rhinoplasty: Problems and Solutions

“…Sometimes it is thought that core of the graft has the least potential for warping so it is suggested to trim the periphery of the graft and to use the core of rib cartilage as the graft material. [29,31]…”