Grafts In Rhinoplasty Research Articles

Rhinoplasties d’augmentation par greffons osseux calvariaux. Résultats à long terme

Various clinical situations may require an important increase of the size of the nose. The aim of our work was to analyze long-term results of calvarial bone grafts used in rhinoplasties. We retrospectively studied the files of 20 patients having undergone a calvarial bone graft. Photogrammetry was used to determine morphological modifications and the stability of results. The average follow-up was 8 years. The parietal donor site morbidity was low. All nose sizes were dramatically augmented and the stability of results ranged between 74.5 and 95%. The calvarial bone graft can be used for important nose augmentation with a good stability. There are few alternative techniques. This method is only limited by available skin and endonasal lining. Calvarial bone graft in rhinoplasty is not frequent but it is our first choice for the correction of important hypoplasia or saddling of the nose.

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

Analysis of the Physical Properties of Costal Cartilage in a Porcine Model

To determine the impact of interventions on the degree of warping of costal cartilage. The project was conducted at a large university animal research laboratory. The costal cartilage of eight 30-kg domestic pigs was harvested. The cartilage was cut into central and peripheral segments with a standard cutting die. Two sizes of rectangular cubes were compared. The central portions of costal cartilage were segmented and glued with octyl-2-cyanoacrylate. The shape of the cartilage was documented with both digital and film photography. The cartilage was placed into subdermal pockets on the dorsum of the pigs. The animals were killed at 4 weeks, and the cartilage was photographed. Adobe Photoshop software was used to measure the degree of warping. Statistical analysis was calculated by t test analysis. A total of 115 rectangular costal cartilage blocks were treated. Large blocks warped less than small blocks (P<.02). Centrally cut blocks warped less than peripherally cut blocks (P<.03). The octyl-2-cyanoacrylate incited a significant sterile inflammatory response such that the blocks could not be accurately assessed for warpage. Costal cartilage can be effectively used for grafting in rhinoplasty with minimal warping if large grafts from the central portion of cartilage are used.

Frequently Used Grafts in Rhinoplasty: Nomenclature and Analysis

After studying this article, the participant should be able to: 1. Accurately name the most frequently used grafts in primary and secondary rhinoplasty. 2. Describe the precise anatomical position of each graft. 3. Discuss the clinical indications of each graft. In this article, the authors present the grafting techniques most commonly used to sculpt the nasal framework in primary and secondary rhinoplasty. The grafts are described in terms of their nomenclature, anatomical location, and clinical indications, presenting a simple and easy-to-reference guide for both beginners and expert surgeons.

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.

Endonasal Placement of Spreader Grafts in Rhinoplasty

Endonasal Placement of Spreader Grafts in Rhinoplasty

Structural grafting in rhinoplasty.

Many surgeons consider cosmetic rhinoplasty to be one of the most challenging facial plastic surgical procedures. Open-structure rhinoplasty allows for visualization of bony-cartilaginous deformities, preservation of nasal structural integrity, and precise nasal reshaping. The ultimate, external appearance of the nose is the sum of the interaction of the bony-cartilaginous skeleton and the skin soft-tissue envelope. This article describes the use of autologous, structural cartilage grafts in primary and secondary rhinoplasty. Emphasis is placed on the use of septal, auricular, and costal cartilage grafts to provide for a structurally sound skeletal framework and thereby a predictable postoperative result. Deformities of the middle and lower third of the nose are specifically addressed.

The Turkish Delight: A Pliable Graft for Rhinoplasty.

Received for publication December 29, 1999. Rod J. Rohrich, M.D. Department of Plastic and Reconstructive Surgery University of Texas Southwestern Medical Center Dallas, Texas 75235 [email protected]

The Turkish delight: a pliable graft for rhinoplasty.

In nose surgery, carved or crushed cartilage used as a graft has some disadvantages, chiefly that it may be perceptible through the nasal skin after tissue resolution is complete. To overcome these problems and to obtain a smoother surface, the authors initiated the use of Surgicel-wrapped diced cartilage. This innovative technique has been used by the authors on 2365 patients over the past 10 years: in 165 patients with traumatic nasal deformity, in 350 patients with postrhinoplasty deformity, and in 1850 patients during primary rhinoplasty. The highlights of the surgical procedure include harvested cartilage (septal, alar, conchal, and sometimes costal) cut in pieces of 0.5 to 1 mm using a no. 11 blade. The fine-textured cartilage mass is then wrapped in one layer of Surgicel and moistened with an antibiotic (rifamycin). The graft is then molded into a cylindrical form and inserted under the dorsal nasal skin. In the lateral wall and tip of the nose, some overcorrection is performed depending on the type of deformity. When the mucosal stitching is complete, this graft can be externally molded, like plasticine, under the dorsal skin. In cases of mild-to-moderate nasal depression, septal and conchal cartilages are used in the same manner to augment the nasal dorsum with consistently effective and durable results. In cases with more severe defects of the nose, costal cartilage is necessary to correct both the length of the nose and the projection of the columella. In patients with recurrent deviation of the nasal bridge, this technique provided a simple solution to the problem. After overexcision of the dorsal part of deviated septal cartilage and insertion of Surgicel-wrapped diced cartilage, a straight nose was obtained in all patients with no recurrence (follow-up of 1 to 10 years). The technique also proved to be highly effective in primary rhinoplasties to camouflage bone irregularities after hump removal in patients with thin nasal skin and/or in cases when excessive hump removal was performed. As a complication, in six patients early postoperative swelling was more than usual. In 16 patients, overcorrection was persistent owing to fibrosis, and in 11 patients resorption was excessive beyond the expected amount. A histologic evaluation was possible in 16 patients, 3, 6, and 12 months postoperatively, by removing thin slices of excess cartilage from the dorsum of the nose during touch-up surgery. This graft showed a mosaic-type alignment of graft cartilage with fibrous tissue connection among the fragments. In conclusion, this type of graft is very easy to apply, because a plasticine-like material is obtained that can be molded with the fingers, giving a smooth surface with desirable form and long-lasting results in all cases. The favorable results obtained by this technique have led the authors to use Surgicel-wrapped diced cartilage routinely in all types of rhinoplasty.

Grafts in rhinoplasty: autogenous grafts are superior to alloplastic.

Grafts in rhinoplasty: autogenous grafts are superior to alloplastic.

Grafts in rhinoplasty: alloplastic vs. autogenous.

Over the past 15 years, grafts have been used with increasing frequency during rhinoplasty procedures as the transition has been made from reductive rhinoplasty to augmentation or restructuring rhinoplasty. There are a number of grafting materials available, including autogenous materials (bone, cartilage), homograft materials (rib cartilage, dermis), and a wide variety of synthetic or alloplastic materials. With regard to the autogenous materials, cartilage has been the mainstay for augmentation in rhinoplasty. Bone is used infrequently because it often yields unsatisfactory results in the aesthetic appearance of the nose, and has problems with graft resorption. I will therefore not discuss bone herein. This article focuses on the differences between autogenous cartilage implants and synthetic materials, in particular expanded PTFE (Gore-tex; WL Gore & Associates Inc, Flagstaff, Ariz). Certainly, there is no argument that autogenous grafts, in particular cartilaginous grafts, are superior as a grafting material in rhinoplasty for a variety of reasons. Cartilaginous grafts are considered the criterion standard by many authors. The more debatable issue is in the case where substantial dorsal augmentation is required: is autologous material preferable to synthetic? Arguments to both support and refute the notion that autologous cartilage is superior will be presented here. Overall, the ideal implant should have biocompatible physical properties. It should retain constant shape and volume and be nonresorbable. Removal should be easy, and migration should not be a problem. As well, the implant should be easily modified and molded, readily available, and cost-effective. On a microscopic level, there should be no inflammatory response, and there should be resistance to infection. The tissue should not degrade, transmit disease, or act as a carcinogen. These characteristics apply to implants throughout the body. Another desirable characteristic with respect to the nose is that in the area of thin skin over the upper dorsum, the implant should be easily camouflaged. These issues as they pertain to both the autogenous and synthetic graft will be addressed and conclusions offered. While comparison of the aesthetic results is impossible and has not been evaluated in a series, patient satisfaction and revision rates will be emphasized. The wide variety of synthetic materials that have been used for the purpose of rhinoplasty is an indication of the need for a perfect alloplastic implant. Through the years, numerous synthetic materials have had relatively high complication rates. I will address only 2 synthetic implants that continue to be used frequently: silicone and expanded PTFE. Silicone is widely used in rhinoplasty for the Asian patient, and the issues relative to this procedure will be addressed. Expanded PTFE has been gaining in popularity over the past 10 years, and results after long-term follow-up will be assessed. PRO

An 18-Year Experience with the Umbrella Graft in Rhinoplasty

Peck, George C. Jr. M.D.; Michelson, Lorelle M.D.; Segal, Jeanett M.D.; Peck, George C. Sr. M.D.; Rohrich, Rod J. M.D.1 Author Information

Structural grafting in rhinoplasty.

The need for structural grafting in rhinoplasty arises when the nasal skeletal framework is weakened, malpositioned, or both. This review will be limited to structural grafting of the cartilaginous nasal skeleton. Current techniques will be reviewed and a technique introduced that addresses the common deformity of a superiorly rotated and deprojected nasal tip complex while simultaneously correcting nasal valve collapse. This technique is referred to as the Dynamic Adjustable Rotational Tip (DART) technique. The operative technique of the DART, as well as the basic philosophy regarding the tensile nature of the cartilaginous nasal skeleton will be described.

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.

Demineralized Bone Grafts in Rhinoplasty

Demineralized Bone Grafts in Rhinoplasty

Distant Effects of Dorsal and Tip Grafting in Rhinoplasty

Grafts to the nasal dorsum and tip, whose local effects are well known, also have distant effects that may not be as readily obvious but that nevertheless are just as real. Dorsal and tip grafts can shorten or lengthen the nose (relatively and absolutely), affect nasal symmetry, preserve or alter nasal ethnic characteristics, and alter dorsum/tip relationships. Each of these properties increases the utility of cartilage and bone grafts in treating a variety of nasal configurations.

Distant Effects of Dorsal and Tip Grafting in Rhinoplasty

Distant Effects of Dorsal and Tip Grafting in Rhinoplasty

Effective pullout of a cartilaginous graft in rhinoplasty

Effective pullout of a cartilaginous graft in rhinoplasty

Effective pullout of a cartilaginous graft in rhinoplasty.

THERE are times in the course of a rhinoplastic operation when a difficult decision must be made as to whether or not a cartilaginous graft should be used. I refer specifically to those cases in which minor depressions of the dorsal bridge or any part of the lateral walls are noticeable. It is possible that if these depressions are left alone, they may in time become filled with fibrous tissue and become unnoticeable. However, there is a greater risk that they will be very evident, thereby creating some obvious defects, such as a saddle nose if the dorsal bridge is very low, or a crooked nose if only one lateral wall is depressed. Yet even though the graft is carefully fitted to the defect in every dimension, it is possible that after several days have passed an unpleasant and pronounced hump may appear which is most disturbing to both