Crushed Cartilage Grafts: Is Overcorrection Necessary?

Abstract

Archives of Facial Plastic SurgeryVol. 10, No. 6 Free AccessCrushed Cartilage Grafts: Is Overcorrection Necessary?Ozcan CakmakOzcan CakmakCorrespondence: Dr Cakmak, Department of Otorhinolaryngology, Baskent University Hospital, 6. Cadde, Bahcelievler, 06490 Ankara, Turkey (E-mail Address: cakmak@baskent-ank.edu.tr)Search for more papers by this authorPublished Online:3 Nov 2008AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail I read the article by Ale de Souza et alref-qle80002-1 with great interest. The authors concluded that crushed grafts had inferior results with lesser chondrocyte viability compared with noncrushed forms, and slight overcorrection was recommended during placement of crushed cartilage grafts. Based on our experimental and clinical findings, I believe the need of overcorrection is highly dependent on the level of crushing applied.Conflicting information exists regarding the viability of the crushed autogenous cartilage grafts and the predictability of their clinical outcomes. Recently, we attempted to resolve these inconsistent results by assessing the influence of the degree of crushing on the rabbit auricularref-qle80002-2 and human nasal septalref-qle80002-3 cartilages, and the clinical outcome of crushed grafts in rhinoplasty.ref-qle80002-4 Our experimental studiesref-qle80002-2,ref-qle80002-3 showed that although significant or severe crushing reduced chondrocyte viability and proliferation, slight or moderate crushing enabled good chondrocyte viability and proliferation rates comparable with those of intact cartilage. Our recent clinical seriesref-qle80002-4 confirmed findings from our previous studiesref-qle80002-2,ref-qle80002-3 that the degree of crushing applied is important for the resorption rates and long-term clinical outcome of crushed cartilage grafts used in rhinoplasty.Ale de Souza et alref-qle80002-1 crushed the rabbits' nasal septal cartilage with 2 moderate forced taps to “soften the surface without reducing the elastic strength of the cartilage”ref-qle80002-1(p251) and defined that grade of crushing as moderate. Although the criteria used by Ale de Souza et alref-qle80002-1 to define the level of crushing are very similar to those used by my group,ref-qle80002-2,ref-qle80002-3,ref-qle80002-4 their term “moderate” may lead to misinterpretations. The degree of crushing was previously defined in my group’s studies as follows: slightly crushed indicates 1 hit of moderate force to soften the surface without reducing cartilage elastic strength; moderately crushed, 2 moderate-force hits to soften the surface and also reduce elastic strength; significantly crushed, 3 to 4 moderate-force hits, enough to cause the graft to bend with gravity; and severely crushed, 5 to 6 forceful hits to totally destroy the integrity of the cartilage.On the one hand, based on our experimental results and clinical experience, significant or severe crushing reduces chondrocyte viability and proliferation and could result in an unpredictable degree of graft volume loss and should not be used as filler material. On the other hand, slight or moderate crushing of the autogenous cartilage produces an outstanding graft material that is effective in concealing irregularities, filling defects, and creating a smoother surface, with excellent long-term clinical outcome and predictable esthetic result without a need for overcorrection.Financial Disclosure: None reported. References Ale de Souza MM, Gregório LC, Sesso R, Souza SA, Settanni F. Study of rabbit septal cartilage grafts placed on the nasal dorsum. Arch Facial Plast Surg. 2008;10(4):250–254 18645093 Abstract, Google ScholarCakmak O, Bircan S, Buyuklu F, Tuncer I, Dal T, Ozluoglu LN. Viability of crushed and diced cartilage grafts: a study in rabbits.. Arch Facial Plast Surg. 2005;7(1):21–26 15655170 Abstract, Google ScholarCakmak O, Buyuklu F, Yilmaz Z, Sahin FI, Tarhan E, Ozluoglu LN. Viability of cultured human nasal septum chondrocytes after crushing.. Arch Facial Plast Surg. 2005;7(6):406–409 16301462 Link, Google ScholarCakmak O, Buyuklu F. Crushed cartilage grafts for concealing irregularities in rhinoplasty.. Arch Facial Plast Surg. 2007;9(5):352–357 17875829 Link, Google ScholarFiguresReferencesRelatedDetailsCited byA Classification for Degree of Crushed Cartilage Ozcan Cakmak and Hande Altintas1 November 2010 | Archives of Facial Plastic Surgery, Vol. 12, No. 6Rhinoplasty A View From the United Kingdom Julian M. Rowe-Jones2 November 2009 | Archives of Facial Plastic Surgery, Vol. 11, No. 6Rhinoplasty at the Global Crossroads Fazil Apaydin2 November 2009 | Archives of Facial Plastic Surgery, Vol. 11, No. 6 Volume 10Issue 6Nov 2008 InformationCopyright 2008 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.To cite this article:Ozcan Cakmak.Crushed Cartilage Grafts: Is Overcorrection Necessary?.Archives of Facial Plastic Surgery.Nov 2008.428-428.http://doi.org/10.1001/archfaci.10.6.4281Published in Volume: 10 Issue 6: November 3, 2008PDF download