Combined use of crushed cartilage and fibrin sealant for radix augmentation in Asian rhinoplasty

Overview

The radix, the deepest point of the nasal bridge between the eyes, is often low in Asian patients and needs building up. Crushed cartilage gives a smooth surface but is loose and hard to keep in position. The authors used a fibrin sealant as a carrier to hold the crushed pieces together as a single mouldable graft, then measured the result on photographs.

Sections of note

• 51 patients, 38 men and 13 women, all had radix augmentation with crushed cartilage during rhinoplasty.
• The graft was the patient's own crushed cartilage stabilised with fibrin sealant into a malleable construct.
• Mean follow-up 18.5 months, range 12 to 25 months.
• Mean increase in radix projection 28.5 percent plus or minus 7.9 percent.
• Mean increase in the nasofrontal angle 11.5 degrees plus or minus 3.8 degrees.
• Outcomes graded excellent in 41.2 percent, good in 37.3 percent, fair in 15.7 percent, unchanged or poor in 5.9 percent. One partial graft resorption (2.0 percent) and two cases of visible graft (3.9 percent).

What it means for a patient

• The technique uses the patient's own cartilage rather than an implant, which avoids implant-specific risks.
• Roughly four in five patients were graded good or excellent, but about one in twenty saw little or no change.
• The two problems seen were the graft partly dissolving and the graft edge showing through the skin.
• Grading was done by review of photographs at a single centre with no comparison technique and no patient-reported scores.

Why this paper matters

Building up the low bridge is the central task in much Asian rhinoplasty, and the choice between solid grafts, crushed cartilage and synthetic implants drives both the look and the complication profile. Fibrin sealant offers a way to keep crushed cartilage where it is put. Whether the added volume holds beyond two years is not answered.

Terms

• Radix: the root of the nose, the deepest point of the bridge between the eyes.
• Augmentation: building up a structure to increase its height or projection.
• Crushed cartilage graft: cartilage flattened and broken up so it moulds smoothly under the skin.
• Fibrin sealant: a surgical glue made from clotting proteins.
• Nasofrontal angle: the angle between the forehead and the bridge of the nose.
• Resorption: gradual absorption and loss of grafted tissue by the body.