Diced Cartilage Grafts in Rhinoplasty Surgery: Current Techniques and Applications

Abstract

The author has used diced cartilage grafts in nasal surgery for more than 30 years. However, the number of cases and the variety of techniques have increased dramatically over the past 6 years. The author uses three methods of diced cartilage in rhinoplasty surgery: diced cartilage, diced cartilage wrapped in fascia (with fascia then sewn closed), and diced cartilage covered with fascia (with the recipient area covered with fascia after graft placement). The constructs are highly varied to fit the specific defect. Pieces of diced cartilage without any fascia can be placed in pockets in the peripyriform area, radix, or alongside structural rib grafts. Over a 2-year period, the author treated 546 rhinoplasty cases in which 79 patients (14 percent) had a total of 91 diced cartilage grafts. There were 34 primary and 45 secondary operations involving the radix (n = 11), half-length grafts (n = 14), full-length dorsum (n = 43), peripyriform (n = 16), infralobule (n = 4), and lateral wall (n = 3). All charts were reviewed for the 256 rhinoplasties performed in 2006 of which 30 patients had 35 diced cartilage grafts. With a median follow-up of 19 months (range, 13 to 25 months), two patients had had revisions unrelated to their diced cartilage grafts. The three most common technical problems were overcorrection, visibility, and junctional step-offs. Diced cartilage grafts are a valuable addition to rhinoplasty surgery. They are highly flexible and useful throughout the nose. Their use simplifies one of the greatest challenges in all of rhinoplasty--dorsal augmentation. Complications have been relatively minor and their correction relatively simple.