Shaved Cartilage Gel Versus Diced Cartilage on Final Dorsal Camouflage: Prospective Study of 200 Patients

Abstract

Importance: Diced cartilage (DC) is a reported technique that has been used for dorsal camouflage after reduction rhinoplasty. Nevertheless, there are certain issues regarding its use on nasal dorsum, especially its variable resorption rate and risk of graft distortion or migration, especially in thin-skinned patients. Recently, regenerative medicine protocols have been used to overcome drawbacks of methods based on DC. Thus, cartilage embedded in platelet-rich fibrin (PRF) has been described as a promising and reliable alternative to existing procedures. Objective: To compare long-term aesthetic outcomes of two different techniques for dorsal camouflage: DC versus shaved cartilage plus platelet-rich fibrin (SC+PRF)-shaved cartilage gel. Design, Setting, and Participants: This is a prospective, interventional, and longitudinal study at an academic tertiary medical center. Participants were 200 consecutive patients undergoing primary reduction rhinoplasty by spare roof technique (SRT) or component dorsal reduction (CDR). Materials and Methods: The inclusion criteria were primary rhinoplasty, in Caucasian patients with dorsal hump, and camouflage of the dorsum by DC or SC+PRF. Exclusion criteria were £18 years of age, revision rhinoplasty and reconstructive rhinoplasty for neoplasic or severe traumatic nasal deformities. The ''Utrecht Questionnaire for outcome assessment in aesthetic rhinoplasty'' was used. Patients answered it before and after surgery (3 and 12 months after). Results: The study population included 200 patients divided into two groups considering the type of dorsal camouflage: DC (n = 132) and shaved cartilage gel (n = 68). The mean age at the time of surgery was 35.44 years (standard deviation -9.78) and the study population included 130 females (65.0%) and 70 males (35.0%). Regarding aesthetic outcomes, analyses of postoperative means showed a significant improvement, in both groups, over time. However, self-assessment, based on the visual analogue scale (VAS), at 12 months postsurgery, was higher for patients with SC+PRF than with DC ( p = 0.004). Twelve months after surgery, patients with thin skin had better aesthetic outcome with SC+PRF than with DC ( p = 0.001). For both reduction rhinoplasty techniques, aesthetic outcomes, based on the VAS at 12 months after surgery, were significantly better for patients with SC+PRF (SRT: p = 0.016; CDR: p = 0.004). For both rhinoplasty approaches, either open or closed, aesthetic outcomes, based on the VAS at 12 months after surgery, were significantly better for patients with SC+PRF (closed approach: p = 0.046; open approach: p = 0.017). Conclusions: SC+PRF provides better long-term aesthetic outcomes, not only for thin-skinned patients, but also for patients who had undergone rhinoplasty by a structured or preservation technique, or by an open or closed approach, for dorsal hump reduction.

Complications of Diced Cartilage Wrapped in Blood Products in Rhinoplasty: A Meta-Analysis

“…In addition, 1 article was included through reference searching 26. Eleven articles were finally included for meta-analysis 11,26–35. The flow diagram explained the selection procedure (Fig.…”

“…26 Eleven articles were finally included for meta-analysis. 11,[26][27][28][29][30][31][32][33][34][35] The flow diagram explained the selection procedure (Fig. 1).…”

Nasal Reconstruction in Granulomatosis with Polyangiitis: A Two Decade Review

“…We have used morselized cartilage, 22 cartilage gel, finely diced cartilage covered with fascia, 23 and, more recently, diced cartilage glue grafts. 24 We have had good results with all these grafts, but these “finer” grafting choices are more susceptible to resorption in the event of a flare up. Lateral wall support is also often necessary, and this is provided by using lateral crural underlay grafts, 25 batten grafts, 26 , 27 and articulated rim grafts.…”

RIB Plaster: a versatile, moldable derivative from scraping the periphery of the rib

“…As well summarized in a recent systematic review, 1 diced cartilage has attracted considerable attention over the years as an easily obtainable and versatile substance for camouflage or augmentation in primary and secondary rhinoplasty. 2–29 Its use has been suggested in various “paste” combinations together with bone dust, 4–6 blood, 7,9 fibrin glue, 10–15 and platelet-rich fibrin. 16,17 Diced cartilage has been commonly enclosed within a fascial envelope as diced cartilage fascia constructs 18–22 and in combinations within premade molds.…”