Use Of Cartilage Research Articles

Characterizing and Modeling Ovine Hide and Costal Cartilage for Use in Modeling High-Rate Non-Penetrating Blunt Impact.

High-rate non-penetrating blunt impacts to the thorax, such as from impacts to protective equipment, can lead to a wide range of thoracic injuries. These injuries can include rib fractures, lung contusions, and abdominal organ contusions. Ovine animals have been used to study such impacts, in a variety of ways, including in silico. To properly model these impacts in silico, it is imperative that the tissues impacted are properly characterized. The objective of this study is to characterize and validate two tissues impacted that are adjacent to the point of impact-costal cartilage and hide. Heretofore, these materials have not been characterized for use in computational models despite their nearly immediate engagement in the high-rate, non-penetrating loading environment. Ovine costal cartilage and hide samples were procured from a local abattoir following USDA regulations. Costal cartilage samples were then cut into ASTM D638 Type V tensile coupons and compressive disks for testing. The cartilage tensile coupons were tested at 150 ε/s, and the compressive samples were tested at -150 ε/s. Identical coupons and disks were then simulated in LS-Dyna using a hyperelastic material model based on test data and experimental boundary conditions. Hide samples were shaved and cut into ASTM D638 Type V tensile coupons and validated in silico using identical boundary conditions and an Ogden rubber model based on test data. The structural responses of costal cartilage and hide are presented and exhibit typical behavior for biological specimens. The respective model fits in LS-Dyna were a hyperelastic- based "simplified rubber" for the costal cartilage and an Ogden rubber for the hide. The costal cartilage had a mean failure strain of 0.094 ± 0.040 in tension and -0.1755 ± 0.0642 in compression. The costal cartilage was also noted to have an order-of-magnitude difference in the stresses observed experimentally between the tensile and compressive experiments. Hide had a mean failure strain of 0.2358 ± 0.1362. The energies for all three simulations showed material stability. Overall, we successfully characterized the mechanical behavior of the hide and costal cartilage in an ovine model. The data are intended for use in computational analogs of the ovine model for testing non-penetrating blunt impact in silico. To improve upon these models, rate sensitivity should be included, which will require additional mechanical testing.

Outcomes of the Use of Fresh-Frozen Costal Cartilage in Rhinoplasty.

Rhinoplasty is made more challenging when there is insufficient septal cartilage for use as graft material. Several autologous and homologous graft options have been used in the past, although each comes with its own set of challenges. Fresh-frozen costal cartilage (FFCC) is an increasingly popular alternative that yields the benefits of homologous tissue while having a lower theoretical risk profile. Given the relatively novel nature of this option, the authors analyzed the complication rates of Musculoskeletal Transplant Foundation FFCC. A retrospective chart review of the use of FFCC in rhinoplasty in the senior author's (R.G.R.) practice was conducted between March of 2018 to December of 2021. A total of 282 cases were reviewed and analyzed for rates of infection, warping, and resorption. Patients with a minimum of 12 months of follow-up were included. The mean age of the study group was 35.8 years, and 27 male and 255 female patients were included. Forty cases were primary rhinoplasties; the remaining 242 were revisions. The mean follow-up period was 20.3 months. Six patients (2.1%) required empiric antibiotics postoperatively; no patient had clinical signs of warping, resorption, or displacement, and 6 patients (2.1%) required operative revision unrelated to the FFCC. This study provides follow-up data on the complication profile of FFCC in rhinoplasty. Acute infection, warping, and resorption rates were found to be no greater than rhinoplasty complication rates when autologous or homologous tissue is used. FFCC is a safe, convenient, and patient-centered option for graft tissue in rhinoplasty. Therapeutic, IV.

Analysis of cognitive framework and biomedical translation of tissue engineering in otolaryngology

Tissue engineering is a relatively recent research area aimed at developing artificial tissues that can restore, maintain, or even improve the anatomical and/or functional integrity of injured tissues. Otolaryngology, as a leading surgical specialty in head and neck surgery, is a candidate for the use of these advanced therapies and medicinal products developed. Nevertheless, a knowledge-based analysis of both areas together is still needed. The dataset was retrieved from the Web of Science database from 1900 to 2020. SciMAT software was used to perform the science mapping analysis and the data for the biomedical translation identification was obtained from the iCite platform. Regarding the analysis of the cognitive structure, we find consolidated research lines, such as the generation of cartilage for use as a graft in reconstructive surgery, reconstruction of microtia, or the closure of perforations of the tympanic membrane. This last research area occupies the most relevant clinical translation with the rest of the areas presenting a lower translational level. In conclusion, Tissue engineering is still in an early translational stage in otolaryngology, otology being the field where most advances have been achieved. Therefore, although otolaryngologists should play an active role in translational research in tissue engineering, greater multidisciplinary efforts are required to promote and encourage the translation of potential clinical applications of tissue engineering for routine clinical use.

Evaluation of articular cartilage wear against pyrolytic carbon in the context of spherical interposition shoulder arthroplasty

Metal shoulder hemiarthroplasty is known to cause failure due to glenoid cartilage erosion. Pyrolytic carbon (PyC), a non-metallic biomaterial, may be an attractive alternative due to its good general tribological characteristics and biocompatibility. We investigated the in vitro biotribological properties of PyC articulated against living cartilage for use as spherical shoulder interposition implant. The evaluation includes a comparison with the typically used cobalt‑chromium‑molybdenum alloy (CoCrMo) and zirconia toughened alumina (ZTA), a more recent biomaterial for hemiarthroplasty. The rate of cartilage degradation was assessed by means of cartilage wear biomarkers (glycosaminoglycans and hydroxyproline) in lubricant and histological changes of the cartilage superficial zone. In addition, the percentage of cell viability and metabolic activity of chondrocytes was assessed. The data revealed that PyC has similar tribological performance in terms of cell viability, cell metabolic activity, and tissue degradation compared to ZTA. Although not significant, CoCrMo affected chondrocyte metabolism and induced a thinner superficial layer with structural defects. There was a combined adsorption of phospholipids and biomarkers on the biomaterials; sGAGs adsorbed between 23 and 43% of the total concentration, and the adsorption rate of phospholipids increased significantly with friction. Biomaterial analysis is required to obtain the full picture of cartilage biomarker release and lubrication mechanisms. Our results suggest that PyC has good tribological performance and compares well with established biomaterials for hemiarthroplasty. It supports the use of PyC in spherical shoulder interposition implant as a viable alternative to conventional metal hemiarthroplasty. Further evaluation of the clinical performance of PyC is required.

Functional and Aesthetic Outcomes of Let Down Dorsal Preservation Rhinoplasty.

Background: Preservation rhinoplasty is a re-emerging technique that lacks data on functional and aesthetic outcomes. Objective: To measure the change in patient-reported nasal aesthetic perception, nasal breathing, and sleep and compare outcomes between two different septal cartilage manipulation techniques among patients undergoing preservation rhinoplasty. Methods: Functional and aesthetic outcomes of a let down dorsal preservation rhinoplasty using either the modified subdorsal strip method (MSSM) or subdorsal Z-flap are assessed pre- and postoperatively using the validated assessment tools Nose Obstruction Symptom Evaluation (NOSE), Sinonasal Outcome Test (SNOT-22), Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS), and Epworth Sleepiness Scale (ESS). Results: Fifty-two patients, 40 women and 12 men ages 15-69 years, underwent dorsal preservation rhinoplasty and the majority reported at 1, 3, 6, and 12 months postoperatively significant improvement based on a paired t-test in NOSE, SNOT-22, SCHNOS, and ESS scores except for ESS scores at 6 and 12 months. No significant difference based on a two-sample t-test was observed between the MSSM and Z-flap techniques implemented. Conclusion: Let down dorsal preservation rhinoplasty with either the MSSM or Z-flap cartilage manipulation technique can achieve significant improvement in nasal aesthetics, nasal breathing, and sleep according to patient responses on validated assessment tools.

Generation and Evaluation of Novel Biomaterials Based on Decellularized Sturgeon Cartilage for Use in Tissue Engineering.

Because cartilage has limited regenerative capability, a fully efficient advanced therapy medicinal product is needed to treat severe cartilage damage. We evaluated a novel biomaterial obtained by decellularizing sturgeon chondral endoskeleton tissue for use in cartilage tissue engineering. In silico analysis suggested high homology between human and sturgeon collagen proteins, and ultra-performance liquid chromatography confirmed that both types of cartilage consisted mainly of the same amino acids. Decellularized sturgeon cartilage was recellularized with human chondrocytes and four types of human mesenchymal stem cells (MSC) and their suitability for generating a cartilage substitute was assessed ex vivo and in vivo. The results supported the biocompatibility of the novel scaffold, as well as its ability to sustain cell adhesion, proliferation and differentiation. In vivo assays showed that the MSC cells in grafted cartilage disks were biosynthetically active and able to remodel the extracellular matrix of cartilage substitutes, with the production of type II collagen and other relevant components, especially when adipose tissue MSC were used. In addition, these cartilage substitutes triggered a pro-regenerative reaction mediated by CD206-positive M2 macrophages. These preliminary results warrant further research to characterize in greater detail the potential clinical translation of these novel cartilage substitutes.

The Harvest of a Lateral Segment of Costal Cartilage for Treating Nasal Deformities.

Although costal cartilage has many uses and is a reliable source of cartilage for rhinoplasty procedures, donor-site complications may arise with conventional harvesting techniques. The present report reports a novel technique of harvesting costal cartilage using a specially designed scalpel and studies the use of the harvested cartilage in the reconstruction of secondary nasal deformities in patients with cleft lips. Ten patients (7 females and 3 males) with nasal deformities secondary to cleft lip underwent rhinoplasty using this new technique at the Department of Oral and Maxillofacial Surgery, Second Hospital of Hebei Medical University, China, between May 2011 and December 2013. Clinical outcomes were evaluated with a follow-up period of 6 to 30 months. The new technique successfully corrected primary nasal deformities, including flat nasal tip, short columella, flaring alae, and asymmetrical nostrils. Surgeons and patients assessed the outcome to be either good or satisfactory. Patients experienced transient discomfort at the wound site but there were no major complications (such as wound infection, dehiscence, exposure, graft extrusion, and pulmonary involvement). The novel technique can harvest a lateral segment of costal cartilage for use in the reconstruction of nasal deformities secondary to cleft lip in a one-stage procedure, with minimal donor-site morbidity.

Safety of Irradiated Homologous Costal Cartilage Graft in Cleft Rhinoplasty.

Autologous cartilage grafts have a low risk of infection and extrusion in cleft rhinoplasty. However, harvesting autologous cartilage involves donor-site morbidity and increased time under anesthesia. Irradiated homologous costal cartilage grafts may be an effective alternative. A retrospective study was performed on patients with a history of cleft lip who underwent rhinoplasty for cleft nasal deformity at Johns Hopkins Hospital from 2009 to 2018. Patients were excluded if their rhinoplasty did not involve a cartilage graft. One hundred sixty-five cleft rhinoplasties (patient age, 2 to 72 years; 52 percent female) were performed. Median follow-up time was 256 days; 30 percent were revision operations. Ninety-six procedures (58 percent) used irradiated homologous costal cartilage grafts, with the remaining using autologous cartilage. Complications resulted from 18 procedures (11 percent), seven (10 percent) involving autologous cartilage and 11 (12 percent) involving irradiated homologous costal cartilage. Most autologous cartilage complications (86 percent) required operative intervention, versus seven of 11 (64 percent) for irradiated homologous costal cartilage. Complications associated with irradiated homologous costal cartilage included infection (n = 5), warping (n = 2), and extrusion (n = 1), while two patients with autologous cartilage experienced collapse and one each experienced resorption, warping, and hypertrophic donor-site scarring. There was no difference between groups regarding complication rate or complications requiring operative intervention (p = 0.3 and p = 0.5, respectively). Irradiated homologous costal cartilage grafts are equally safe and effective as autologous cartilage for use in cleft rhinoplasty. These grafts are readily available and eliminate donor-site morbidity. Therapeutic, III.

A New Cartilage-Sparing Procedure for Correction of the Prominent Ear Deformity: Dermal Anchor Technique.

Although the literature is replete with surgical techniques described for correction of the prominent ears, new techniques are still needed to minimize the recurrence rates and postoperative complications. Here, the author presents a new and simple otoplasty procedure, namely, the dermal anchor technique (DAT), in which a wide planar adhesion between the opposing dermal surfaces of the deepithelized antihelical groove is used as a biological anchor for long-term maintenance of the antihelical fold without any cartilage manipulation. For 12 years, this new procedure was used for correction of 76 prominent ears in 44 patients, with 17 being female and 27 being male. The ages of the patients ranged from 5 to 37 years. In 28 patients, the DAT was combined with conchal excision and/or concha-mastoid sutures as required, whereas it was used alone in the remaining 16 patients. The preoperative and postoperative distance between the ear and the head was measured at 4 points (superior helical point, superior conchal attachment, inferior conchal attachment, and lobules). All patients healed uneventfully. Except mild edema and pain, there was no postoperative problem. The mean follow-up time was 4½ years (4 months-10 years). During this time, there was no patient with surface irregularities and/or suture-related complications. Two patients required revision because of unilateral lateralization of the upper pole by time (recurrence rate, 2.63%). When the preoperative and postoperative superior helical point, superior conchal attachment, inferior conchal attachment, and lobule measurements for both ears of the patients who were operated on were compared, postoperative values were determined to be significantly decreased (P < 0.001). The DAT provides predictable and aesthetically satisfactory long-lasting results with a minimal risk of complications. Because it does not harm the cartilage tissue, it avoids the potential problems resulted from cartilage manipulations such as surface irregularities and chondritis. Covering the suture knots with a thick soft tissue layer, it eliminates the suture-related complications. Moreover, it offers a direct approach and does not require anterior dissection. Thus, it requires a shorter operative time, minimizes the risk of anterior skin necrosis and hematoma, and causes less postoperative pain, edema, and ecchymosis.

A decellularized scaffold derived from squid cranial cartilage for use in cartilage tissue engineering.

Decellularized cartilage scaffold (DCS) is an emerging substitute for cartilage defect application. However, it is hard to preserve an intact structure of such scaffolds derived from terrestrial animals, because of their dense and compact constitution. In contrast, squid (Dosidicus gigas) cranial cartilage, which possesses a relatively loose structure, could be easily decellularized using mild conditions and it retains the original microstructures of extracellular matrix (ECM). Herein, decellularized squid cranial cartilage scaffold (DSCS) was fabricated successfully after substantially removing the cells, which contained abundant ECM components (proteoglycans and type II collagen). Microscopic structure results showed that the DSCS possesses a relatively smooth and dense surface with a favorable interconnected inner porous structure for cell growth. DSCS exhibited excellent biomechanics and hydrophilicity. In vitro experiments indicated that the scaffold extracts were not toxic to cells, and were amenable to chondrocyte migration. Meanwhile, chondrocytes seeded in DSCS could maintain a favorable viability and present a spreading morphology. Furthermore, the in vivo experiments revealed that both cell-free scaffold and cell-laden scaffold exert promotive effects for the regeneration of cartilage in a full-thickness rabbit cartilage defect model. Taken together, these results suggested that DSCS presents a novel and promising cell-free therapeutic choice for cartilage tissue engineering.

Characterization of Injury Induced by Routine Surgical Manipulations of Nasal Septal Cartilage.

This study characterizes and compares common surgical manipulations' effects on septal cartilage to understand their implications for rhinoplasty outcomes based on cell viability and cartilage health. To illustrate distinct differences in the impact of various surgical manipulations on septal cartilage in an in vitro septal cartilage model. A secondary objective is to better understand the chondrocyte's response to injury as well as how alterations in the extracellular matrix correspond to chondrocyte viability. In this bench-top in vitro porcine model using juvenile bovine septal cartilage from bovine snouts, easily obtainable septal cartilage was used to generate large numbers of homogenous cartilage specimens. Quantitative outcomes at early and late time points were cell viability, cell stress, matrix loss, and qualitative assessment through histologic examination. The study was performed at a single academic tertiary care research hospital. Four common surgical manipulations were contrasted with a control group: crushed cartilage, scored cartilage, diced cartilage, and shaved cartilage. Following the manipulation of the cartilage, the quantitative outcomes were glycosaminoglycan release to the media, lactate dehydrogenase release to the media, and cell death analysis through apoptosis staining. The qualitative outcomes were histologic staining of the manipulated cartilage with safranin-O/fast green stain to identify proteoglycan loss. The crushing followed by shaving manipulations were the most damaging as indicated by increased levels of lactate dehydrogenase release, glycosaminoglycans loss, and cell death. Matrix loss did not increase until after 48 hours postinjury. Furthermore, chondrocyte death was seen early after injury and accelerated to the late time point, day 9, in all manipulations. Conversely, cell stress was found to be greater at 48 hours postinjury, which then declined to the late time point, day 9. The crushing manipulation followed by shaving and then dicing were the most destructive methods of cartilage manipulation relative to control specimens. Collectively, these outcomes demonstrate the range of injury which occurs with all septal cartilage manipulations and can inform rhinoplasty practice to use the least damaging effective surgical manipulation to obtain the desired outcome. NA.

The Rabbit Costal Cartilage Reconstructive Surgical Model

Rib grafts in facial plastic surgery are becoming more frequently used. Small animal models, although not ideal may be used to emulate costal cartilage-based procedures. A surgical characterization of this tissue will assist future research in the selection of appropriate costal segments, based on quantitative and qualitative properties. The objective of this study is to assess the surgical anatomy of the rabbit costal margin and evaluate costal cartilage for use in either in vivo or ex vivo studies and to examine reconstructive procedures. Detailed thoracic dissections of 21 New Zealand white rabbits were performed post-mortem. Costal cartilage of true, false, and floating ribs were harvested. The length, thickness, and width at proximal, medial, and distal locations of the cartilage, with perichondrium intact were measured. Further qualitative observation and digital images of curvature, flexibility, and segmental cross-sectional shape were recorded. The main outcome measure(s) is to characterize, describe, and assess the consistency of dimensions, location, and shape of costal cartilage. In this study, 12 to 13 ribs encase the thoracic cavity. Cartilage from true ribs has an average length, width, and depth of 23.75 ± 0.662, 3.02 ± 0.025, and 2.18 ± 0.018 mm, respectively. The cartilage from false ribs has an average length, width, and depth of 41.97 ± 1.48, 2.00 ± 0.07, 1.19 ± 0.03 mm, and that of floating ribs are 7.66 ± 0.29, 1.98 ± 0.04, and 0.96 ± 0.03 mm. Rib 8 is found to be the longest costal cartilage (49.10 ± 0.64 mm), with the widest and thickest at ribs 1 (3.91 ± 0.08 mm) and 6 (2.41 ± 0.11 mm), respectively. Cross-sectional segments reveal the distal cartilage to maintain an hourglass shape that broadens to become circular and eventually ovoid at the costochondral junction. The New Zealand white rabbit is a practical source of costal cartilage that is of sufficient size and reproducibility to use in surgical research where the long-term effects of operations, therapies, devices, and pharmacologic on cartilage can be studied in vivo.

Bulbous Tip Correction Focusing on Skin Soft Tissue Envelope in Asian Rhinoplasty

Background Correction of a bulbous tip is a difficult procedure in Asians, because their lower lateral cartilage is relatively small and structurally weak to support the thick skin soft tissue envelope (SSTE). Therefore, lower lateral cartilage manipulation alone yields inadequate bulbous tip correction. In this study, authors aim to provide a new bulbous tip definition reflecting nasal tip SSTE and categorization with a suitable surgical proce- dure. Methods One hundred sixty-three patients with tip rhinoplasty between January 2009 and December 2012 were studied who had a tip lobular width greater than 60% of the alar base width. Depending on cartilage size and characteristics of the nasal tip superfi- cial musculoaponeurotic system (SMAS) with SSTE thickness, the following classifica- tions were made: Group I: thin SSTE with a large lower lateral cartilage, Group II: thick SSTE with a small lower lateral cartilage, Group IIa: thick SSTE with loose SMAS, and Group IIb: thick SSTE with dense SMAS. We evaluated the degree of surgical improve- ment by comparing pre- and postoperative photographs. Results After comparing pre- and postoperative photos, we observed improvements in tip bulbosity by 11.7% in Group I (n = 41), 11.9% in Group IIa (n = 64), and 7.1% in Group IIb (n = 58). Conclusions In Asians, nasal tip bulbosity is often due to excess SSTE. Therefore, a bul- bous tip should be defined and evaluated based on its underlying SSTE. Adequate soft tissue resection in addition to lower lateral cartilage support and manipulation are war- ranted to achieve a refined tip.

Anatomical Variations of the Upper Lateral Cartilages and Their Implications in Rhinoplasty

Upper lateral cartilage manipulation is often associated with compromise of the middle-third vault. Although the anatomical details of the upper lateral cartilages are of great importance for the maintenance or even the creation of an aesthetically pleasing dorsum with proper respiratory function, the literature includes few studies related to these themes. Thus, this study aimed to evaluate the total length of the upper lateral cartilages and their extension under the nasal bones and caudally, and examine the anatomical variations of the upper lateral cartilages and their implications in rhinoplasty. An anatomical study was performed on 32 upper lateral cartilages of 16 fresh adult cadavers. The upper lateral cartilages were measured for total length, cephalad length (overlapped by the nasal bones), and caudal length (caudally to the nasal bones) using a millimeter ruler. The measurements were recorded and analyzed by BioEstat 5.0 software. The statistical tests were performed at the significance level of 0.05. A total of 13 male specimens and 3 female specimens with ages ranging between 20 and 60years were analyzed. The length of the upper lateral cartilage portion under the nasal bones on the right side ranged from 3 to 7mm (4.62±1.20mm). On the left side, it ranged from 2 to 7mm (4.56±1.26mm). The total length of the upper lateral cartilages ranged from 16 to 28mm (20.44±3.26mm) on the right side and 17 to 30mm (20.75±3.71mm) on the left side. Data from this study confirmed the anatomical variations of the upper lateral cartilages, including the portion lying under the nasal bones. This has important surgical implications given the attention required during spreader graft fabrication in order to maintain dorsal aesthetic lines and proper respiratory function.

A Pseudo-Elastic Effective Material Property Representation of the Costal Cartilage for Use in Finite Element Models of the Whole Human Body

Objective: Injury-predictive finite element (FE) models of the chest must reproduce the structural coupling behavior of the costal cartilage accurately. Gross heterogeneities (the perichondrium and calcifications) may cause models developed based on local material properties to erroneously predict the structural behavior of cartilage segments. This study sought to determine the pseudo-elastic effective material properties required to reproduce the structural behavior of the costal cartilage under loading similar to what might occur in a frontal automobile collision. Methods: Twenty-eight segments of cadaveric costal cartilage were subjected to cantilever-like, dynamic loading. Three limited-mesh FE models were then developed for each specimen, having element sizes of 10 mm (typical of current whole-body FE models), 3 mm, and 2 mm. The cartilage was represented as a homogeneous, isotropic, linear elastic material. The elastic moduli of the cartilage models were optimized to fit the anterior–posterior (x-axis) force versus displacement responses observed in the experiments. For a subset of specimens, additional model validation tests were performed under a second boundary condition. Results: The pseudo-elastic effective moduli ranged from 4.8 to 49 MPa, with an average and standard deviation of 22 ± 13.6 MPa. The models were limited in their ability to reproduce the lateral (y-axis) force responses observed in the experiments. The prediction of the x-axis and y-axis forces in the second boundary condition varied. Neither the effective moduli nor the model fit were significantly affected (Student's t-test, p < 0.05) by the model mesh density. The average pseudo-elastic effective moduli were significantly (p < 0.05) greater than local costal cartilage modulus values reported in the literature. Conclusions: These results are consistent with the presence of stiffening heterogeneities within the costal cartilage structure. These effective modulus values may provide guidance for the representation of the costal cartilage in whole-body FE models where these heterogeneities cannot be modeled distinctly.

Versatility of Three-Dimensional Total Alar Cartilage Dissection in Aesthetic Rhinoplasty

In many cases, Asians' noses are shorter; their nasal tips have a bulbous shape and typically lack the projection. To correct these problems, we completely dissected the alar cartilage in a three-dimensional manner by which the alar cartilage could be repositioned. Thus, no external force was exerted to the alar cartilage. For approximately 4 years, a total of 502 patients were treated with this surgical method. Using the open rhinoplasty, the alar cartilage was dissected in such a manner that it should be completely isolated from the skin, nasal mucosa, and upper lateral cartilage in 3 layers. Thereafter, using various nasal tip plasty techniques, the alar cartilage was reshaped and then repositioned. Patients were followed up for a mean period of 18 months. Then, the degree of subjective satisfaction of patients was analyzed with the use of 4-point visual analog scale scores. On the assessment of the degree of subjective satisfaction of patients, of a total of 502 patients, 87% responded as "very satisfactory" or "satisfactory." Through an analysis of the photographs taken before and after surgery, in patients with a short nose, the current surgical procedure was effective in extending the length of nose without the septal extension graft. The nasolabial angle was ideally expressed. Through meticulous cartilage manipulation, the tip projection improved and a bulbous shape of the nasal tip was resolved. In an aesthetic rhinoplasty for Asians, if plastic surgery of the nasal tip should be performed using a three-dimensional dissection of the alar cartilage, it would be helpful for surgeons to effectively and freely manipulate the alar cartilage according to their plans.

Comparison of bend angle measurements in fresh cryopreserved cartilage specimens after electromechanical reshaping

Cryopreservation of cartilage has been investigated for decades and is currently an established protocol. However, the reliability and applicability of cartilage cryopreservation for the use in electromechanical reshaping (EMR) has not been studied exclusively. A system to cryopreserve large numbers of tissue specimens provides a steady source of cartilage of similar quality for experimentation at later dates. This will reduce error that may arise from different cartilage stock, and has the potential to maximize efficiency under time constraints. Our study utilizes a unique methodology to cryopreserve septal cartilage for use in EMR studies. Rabbit septal cartilage specimens were harvested and standardized to 20 x 8 x 1 mm, and placed in one of three solutions (normal saline, PBS, 10% DMSO in PBS) for four hours in a cold storage room at 4 degrees Celsius. Then, each cartilage specimen was vacuumed and sealed in an anti-frost plastic bag and stored in a freezer at -80 degrees Celsius for 1 to 3 weeks duration. EMR was performed using 2 and 6 volts for 2 minutes application time. Bend angle measurements of the cryopreserved cartilage specimens were compared to bend angles of fresh cartilage which underwent EMR using the same parameters. Results demonstrate that normal saline, phosphate buffered saline (PBS), and PBS with DMSO were effective in cryopreservation, and indicated no significant differences in bend angle measurements when compared to no cryopreservation. Our methodology to cryopreserve cartilage specimens provides a successful approach for use in conducting large-scale EMR studies.

The Decision Process in Choosing Costal Cartilage for Use in Revision Rhinoplasty

The aims of rhinoplasty reconstruction include maintaining or augmenting long-term tip projection, restoring rigid dorsal stability, and restoring optimum respiratory function. The methods set forth to obtain these objectives are inherently based on the intrinsic nasal principles at the time of the rhinoplasty. Because of the excellent and consistent results autologous costal cartilage grafts provide when faced with problems such as the traumatic saddle deformity, defects after neoplastic resection, congenital nasal deformities, severe tip weakness or underprojection, rhinoplasty in the ethnic patient, and revision rhinoplasty, they are an invaluable resource to the rhinoplasty surgeon. Once the surgeon becomes comfortable and proficient at harvesting this graft, it inevitably will become the graft of choice when substantial amounts of cartilage are required.

An ex-vivo study of the potential use of bipolar diathermy for cartilage manipulation in otoplasty

An ex-vivo study of the potential use of bipolar diathermy for cartilage manipulation in otoplasty

The Use of Injectable Silicone Microdroplets to Improve Small Facial Defects and Imperfections in the Nose

Introduction: After rhinoplasty, an imperfection often becomes apparent after healing. Such imperfections usually present as a depression that can be corrected using a serial puncture technique with the injection of sequential microdroplets of silicone. The injection technique, results, and minor complications are presented. Materials and Methods: The technique using microdroplets of 1000-centistoke silicone injected through a 30-gauge needle into depressions around the nose is presented. Seven patients are chosen to illustrate the procedure. Results: Preinjection and postinjection photographs demonstrate the degree of correction of minor imperfections without adverse tissue reactions. Discussion: Silicone offers a safe and easier alternative to saving a patient's own cartilage for use as filler material. Storing cartilage requires a refrigerated germicidal solution and a tissue bank license. Using a serial puncture technique with the injection of microdroplets of silicone is an easier and more rapid method of correction than performing surgery again and implanting cartilage or other solid filler material. Although silicone is not absolutely inert, it elicits less physiological activity than any other foreign substance known today. It is indestructible and nonallergenic; it is never metabolized; it does not support bacterial growth; and no immunologic diseases have been associated with it. The eventual response to its injection is fibrosis resulting in slightly increased collagen deposition localized to the immediate surrounding area. The fibrosis is self-limited and does not become extensive. Conclusion: When properly used, pure liquid silicone ranks as one of the most remarkable substances to emerge in the field of cosmetic surgery. In this author's opinion, it is the “gold standard” of all injectables. This modality is inexpensive with no downtime, it is an office procedure that is rapid with minimal discomfort, and it is extremely safe.