Cartilage Grafts In Rhinoplasty Research Articles

Cartilage Warping in Rhinoplasty: An Assessment of Temperature, Carving, and Suturing Conditions

Abstract Goals/Purpose Rhinoplasty is often contingent on the successful harvesting and allocation of cartilage in order to build the nasal framework. While autologous and cadaveric cartilage grafts have been utilized, it remains unclear how factors, such as suturing and carving techniques, as well as temperature, impact its short- and long-term warping potential. Our systematic review seeks to objectively assess how various carving (i.e. peripheral versus central, eccentric versus concentric), suture patterns (i.e. counter-balancing, oppositional), and temperature conditions impact the warping potential of cartilage grafts in rhinoplasty. In conducting this study, we hope to determine the optimal conditions for stable cartilage constructs in rhinoplasty. Methods/Technique A systematic literature review was conducted using a combination of terms including, “warp,” “rhinoplasty,” “cartilage,” “suture,” “temperature,” “carving,” and “cutting.” Removal of duplicates was performed, followed by further screening by abstract and full text. To reduce the possibility of bias, a standardized form was used for data extraction; variables including author, year of publication, journal of publication, study design, conditions, and results were recorded. Results/Complications A total of eleven studies were included in the analysis. Cartilage types included fresh frozen cadaveric graft, autologous costal cartilage, and bovine rib cartilage. Conditions associated with reduced warping include central and concentric based carving patterns, oppositional suturing; Peripherally and eccentric cut cartilage, as well as increased time, were associated with a higher degree of warping. Conclusion To the authors’ knowledge, our systematic analysis is the first to summarize the impact of various conditions on cartilage warping in rhinoplasty. Moreover, we determine the protective nature of certain carving and suturing methods - particularly central, concentric carving, and oppositional suturing - in minimizing cartilage warping. With this information, we hope to guide plastic surgeons in optimizing conditions to potentially prevent cartilage warping, and ultimately, provide reliable and sustainable results for patients undergoing rhinoplasty.

Commentary on: "Outcomes of Autologous Versus Irradiated Homologous Costal Cartilage Grafts in Rhinoplasty" by Virginia E. Drake et al.

In this commentary, I discuss Drake et al.'s manuscript, "Outcomes of Autologous versus Irradiated Homologous Costal Cartilage Grafts in Rhinoplasty"1 and its greater implications for cartilage selection for grafting in septorhinoplasty. The authors provide a robust institutional example of the similarities shared between both autologous costal cartilage and irradiated homologous costal cartilage in terms of warping, infection, resorption, and overall result possible. This study adds to the current body of literature regarding this topic and helps surgeons make better, evidence-based decisions regarding cartilage grafting for their rhinoplasty patients.

Histology and Long-term Clinical Outcome of Crushed Cartilage with Double-layer Gelatin Sponge Membrane for Dorsum Refinement in Primary Rhinoplasty.

This article demonstrates the ability to use autologous crushed cartilage grafts in rhinoplasty with rapid recovery and optimal nasal functionality without any tissue damage and allows its rapid rejuvenation. Eligible patients underwent primary rhinoplasty using autologous crushed cartilage graft followed by microscopy imaging of the grafted tissue after recovery. Tissue and cytological analysis using optical microscopy, transmission electronic microscopy (TEM), and scanning electronic microscopy (SEM) showed complete viability of chondrocytes, formation of new collagen fibers, neo-perichondrium, neo-angiogenesis, and exhibiting optimal aesthetic outcome. The surgical approach is easy to perform, feasible, and less time-consuming, with excellent tissue rejuvenation and rapid recovery.

Reconstruction of an iatrogenic anterior conchal defect with a revolving-door flap

BackgroundAuricular concha has been widely used as a supporting material in rhinoplasty or repairing of auricular defects. However, complications, trauma or iatrogenic excision often result in concha defects which destroy the normal structure of the external ear and further influence daily life. Local flaps are often applied to repair the defects because of their safety and satisfactory functional and aesthetic results.Case presentationWe report a 24-year-old female who presented with a concha defect that resulted from a complication of concha cartilage graft for rhinoplasty. The anterior concha defect was covered by a revolving-door (RD) flap as a single-stage procedure. The aesthetic and functional outcomes were satisfactory at 6 months post operation.ConclusionWe recommend the RD flap as an excellent choice for conchal defect reconstruction. Satisfactory aesthetic and functional results can be achieved by this easy-to-learn technique in relatively short surgical time.

Cadaveric Costal Cartilage Grafts in Rhinoplasty and Septorhinoplasty: A Systematic Review and Meta-Analysis of Patient-Reported Functional Outcomes and Complications.

Irradiated cadaveric costal cartilage (CC) has been utilized as an alternative to autologous cartilage (AC) in functional and aesthetic nasal surgery. The impact of graft choice between AC and CC on functional outcomes in rhinoplasty has yet to be studied. A systematic review was performed in PubMed, Embase, and Cochrane databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify comparative studies evaluating the efficacy and safety of CC in nasal surgery. Functional and aesthetic outcomes and complications were reviewed and compared between AC and CC. Meta-analytic comparisons were performed when appropriate using data from comparative studies using a random-effects model. Four studies met inclusion criteria. The indication for surgery was functional in the majority of cases, and 34.6% of cases were revision rhino- or septorhinoplasties. Disparate data across studies prevented meta-analysis on functional outcomes; however, qualitative review of function outcomes demonstrated comparable outcomes between the CC and AC groups. No differences in graft infection, warping, and resorption rates were detected. Analysis of all graft-related complications was higher in the CC group (P = 0.02); however, when AC donor site-related complications were included, no significance between the two groups was observed. In conclusion, limited, high quality data was available for analysis. Of the available studies, this systematic review suggest that the use of AC or CC may lead to comparable results in terms of functional outcomes. More long-term studies directly comparing AC and CC functional outcomes would be welcomed.

Outcome of Free Diced Cartilage Grafts in Rhinoplasty: A Systematic Review.

Diced cartilage grafts are used to increase and refine the nasal contour, providing easy molding and versatility when compared with block grafts. However, all grafts present the possibility of visibility, distortion, and absorption. The aim of this study is to evaluate, through a systematic review, the outcome of the use of the free diced graft cartilage in rhinoplasty. A systematic search of the literature was performed in the databases (PubMed, Lilacs, Scielo, Cochrane) with the terms "diced cartilage" and "rhinoplasty." Studies were selected according to the inclusion and exclusion criteria and data extracted and grouped for analysis. Six eligible studies were included. In total, 4,044 patients underwent rhinoplasty with free diced cartilage graft, with 61 (1.51%) of them requiring reoperation. The main reasons were overcorrection and irregularities of the nasal dorsum. The infection rate was reported in three studies, with 2 (0.06%) of 3,252 patients presenting infection at the graft site. Two cases of displacement were treated with external molding, without reoperation. The graft resorption was reported in four articles, which described 22 (0.67%) cases of partial resorption in 3,288 patients. Therefore, the available evidence suggests that resorption of the graft and unfavorable outcomes are rare.

Effect of scopoletin on fascia-wrapped diced cartilage grafts

Purpose: To evaluate the effect of scopoletin (SL) on fascia-wrapped diced cartilage grafts in rhinoplasty surgery.Methods: Cartilage grafts (2 × 2 cm) from the ears of New Zealand rabbits were diced into sections (1 mm3) and then wrapped in muscle fascia taken from the right rear leg. Each graft was placed on the back of the animal after measuring its weight, and then the rabbits were separated into two groups, viz, control and the SL-treated groups {10 mg/kg, per os (p.o.)}. The treatments were administered for 3 months, the rabbits were sacrificed, and the histopathological features and weight of the grafts were examined.Results: The weight of the grafts in the two groups did not significantly (p < 0.05) differ but the histopathological results suggested that there was a pronounced increase in the viability of the graft tissues in the SL-treated group compared to the control group. Treatment with SL decreased the resorption rate and enhanced basophilia relative to the control group. However, fibrosis, inflammation, and bone metaplasia- and calcification-like factors did not significantly differ (p < 0.05).Conclusion: Treatment with SL significantly enhances the viability of the grafts, and thus may have a beneficial effect on fascia-wrapped diced cartilage grafts.Keywords: Scopoletin, Rhinoplasty surgery, Fascia-wrapped diced cartilage graft, Histopathology, Basophilia, Inflammation

Use of tragal cartilage grafts in rhinoplasty: An anatomic study and review of the literature.

We conducted a cadaveric study to determine the size of cartilage grafts that can be taken from the tragus without distorting tragal anatomy. Our subjects included 7 fresh cadavers-3 male and 4 female (age at death: 61 to 87 yr). Tragal cartilage grafts were harvested while leaving the lateral 3 mm of the tragal cartilage in situ to preserve the anatomic shape of the tragus. The grafts were measured and their dimensions recorded. The craniocaudal dimensions of the tragal cartilages ranged from 15 to 30 mm (mean: 21.6), and the width of each specimen ranged from 10 to 23 mm (mean: 15.3). The thickness of the cartilage was approximately 1 mm. The grafts were slightly curved along their long axis. We also review the literature regarding the dimensions of different grafts used in rhinoplasty, knowledge of which can help in preoperative planning. Tragal cartilage grafts have been used as shield, alar contour, alar batten, lateral crural onlay, dorsal onlay, and infratip lobule grafts. When a straight and/or thick graft is needed, two strips of tragal cartilage can be sutured in a mirror-image configuration.

‘Scratch pad’ technique for refinement of cartilage grafts in rhinoplasty and ear reconstructive surgery: a technical innovation

Clinical OtolaryngologyVolume 37, Issue 2 p. 166-167 CORRESPONDENCE: LETTERS ‘Scratch pad’ technique for refinement of cartilage grafts in rhinoplasty and ear reconstructive surgery: a technical innovation B. Ranganathan, B. Ranganathan University Department of Otorhinolaryngology – Head and Neck Surgery, Manchester Royal Infirmary, Manchester, UK. E-mail: [email protected]Search for more papers by this authorT.J. Woolford, T.J. Woolford University Department of Otorhinolaryngology – Head and Neck Surgery, Manchester Royal Infirmary, Manchester, UK. E-mail: [email protected]Search for more papers by this author B. Ranganathan, B. Ranganathan University Department of Otorhinolaryngology – Head and Neck Surgery, Manchester Royal Infirmary, Manchester, UK. E-mail: [email protected]Search for more papers by this authorT.J. Woolford, T.J. Woolford University Department of Otorhinolaryngology – Head and Neck Surgery, Manchester Royal Infirmary, Manchester, UK. E-mail: [email protected]Search for more papers by this author First published: 20 April 2012 https://doi.org/10.1111/j.1749-4486.2012.02461.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume37, Issue2April 2012Pages 166-167 RelatedInformation

Rhinoplasty Sizers

Templates and sizers are used as tools to assist in the design and construction of both structural and artistic works. These templates and sizers are used frequently in the field of aesthetic and reconstructive surgery. The use of a template to assist with construction of cartilage grafts in rhinoplasty allows the surgeon to sculpt by replicating the template model. Templates and sizers are useful and advantageous tools in the rhinoplasty operation.

Interpositional Cartilage Grafts to Improve Vertical Length of the Face

Most plastic surgeons in the past used bone grafts for nasal augmentation and for augmentation of the middle third of the face, and we, in our service, also used bone grafts at that time. Later, however, most plastic surgeons changed, and cartilage grafts are now the favorite material for rhinoplasty. For many years, we used cartilage grafts in rhinoplasty, and we now report the use of cartilage grafts to augment the length of the middle third of the face. We performed an osteotomy Le Fort I and harvest cartilage grafts from the costal region; then, we placed cartilage grafts between the upper portion and the lower portion of the maxilla to augment the vertical dimension of the middle third of the face. Results in our patients were excellent. Instead of bone grafts, cartilage grafts can be used as a good alternative to augment the vertical dimension of the maxilla.

Tragal cartilage grafts in rhinoplasty: A viable alternative in the graft-depleted patient

To describe a simple technique for harvesting tragal cartilage and describe its use in rhinoplasty. Retrospective review. Rhinoplasties performed between January 2005 and June 2007 in which tragal cartilage grafts were utilized by the senior author (CSC) were reviewed to assess type of graft, preservation of tragal contour, and donor-site morbidity. Tragal cartilage grafts were used in three primary and three secondary rhinoplasty patients. Postoperative follow-up ranged from six months to 12 months. Tragal cartilage was used as five alar contour grafts, one lateral crural onlay graft, one dorsal onlay graft, and one infratip lobule graft. Tragal cartilage was used to close the septal perforation of one patient. Tragal contour was preserved in all patients, and there were no complications noted with this procedure. The tragus provides a simple, convenient alternative source of cartilage for rhinoplasty in graft-depleted patients.

The Role of Diced Cartilage Grafts in Rhinoplasty

The Role of Diced Cartilage Grafts in Rhinoplasty

The role of diced cartilage grafts in rhinoplasty

For the author, diced cartilage grafts have revolutionized dorsal grafts in rhinoplasty, replacing layered septal grafts, stacked conchal grafts, and carved costal cartilage grafts. He asserts that diced cartilage wrapped in fascia is simpler to use, quicker, and aesthetically superior to solid cartilage grafts, without risks of warping, malalignment and K-wire extrusion.

The use of percutaneous sutures for graft fixation in rhinoplasty.

We reviewed our 10-year experience using percutaneous suturing to secure cartilage grafts in rhinoplasty. A total of 382 patients having up to 4 percutaneous sutures per surgery were analyzed. Cases using this suture technique included lower lateral onlay grafts, dorsal onlay grafts, tip grafts, and intact conchal cartilage grafts to repair nasal valve collapse. Sutures are ideally placed in a horizontal mattress fashion beginning at the skin surface, continuing into the nasal cavity, and then out through the skin. Sutures are strategically placed to secure the graft and at times stent open the nasal valve. The suture is tied loosely over the skin taking in to consideration the anticipated edema formation. There is no need to use a bolster technique. Sutures are removed at the second postoperative visit. Long-term follow-up reveals precise graft placement. There are in most instances no visible suture marks and our results achieve over 95% patient satisfaction. Percutaneous suture placement is a simple technique that allows precise graft placement and fixation without resultant scarring. It coapts the skin and soft tissues to the grafted nasal skeleton and prevents fluid accumulation, hematoma formation, and graft migration. We believe that it aids in decrease long-term tissue edema and excessive fibrosis, therefore promoting quicker healing. Our patients are both functionally and cosmetically pleased.

Conchal cartilage grafts in rhinoplasty.

Conchal cartilage grafts in rhinoplasty.

Conchal Cartilage Grafts in Rhinoplasty

SummaryConchal cartilage grafts were used in 38 patients during rhinoplasty. They were used for dorsum augmentation, contour correction and correction of tip deformities. Due to ease in harvesting, lack of donor deformities and the absence of warping and absorption we found the conchal cartilage an ideal donor material. It was used for the correction of cleft lip nose deformity, correction of depressed bridge, and tip problems. Technique of harvesting is simple and there was no donor site problem.

The value of bone and cartilage grafts in rhinoplasty

The value of bone and cartilage grafts in rhinoplasty