Use of Diced Conchal Cartilage with Perichondrial Attachment in Rhinoplasty

Overview

Cartilage taken from the bowl of the ear is popular for tip work but has been considered too small and too curved for building up the bridge. The authors kept the perichondrium attached, diced the cartilage against it, and used the resulting sheet as an augmentation material. They reviewed records and before and after photographs at a tertiary academic centre.

Sections of note

• Retrospective review of 37 rhinoplasty patients.
• The graft was used alone in 22 patients (59.5 percent) and combined with other cartilage, donated fascia lata or expanded polytetrafluoroethylene in 15 patients (40.5 percent).
• Bridge augmentation in 30 patients (81.1 percent) and radix augmentation in nine (24.3 percent), both with significantly increased height after surgery (p less than 0.01 each).
• Four patients (10.8 percent) had tip surgery with the graft. Aesthetic outcomes were judged successful but measured tip projection and rotation did not change significantly (p greater than 0.05).
• Complications were a hematoma and a keloid at the ear donor site.
• Poor aesthetic outcome in four patients (10.8 percent). Level of evidence 4, therapeutic.

What it means for a patient

• Ear cartilage can be harvested through a hidden incision and avoids taking cartilage from the rib or the chest.
• The technique reliably raised the bridge and the radix, but did not measurably change the tip even where the appearance was judged good.
• About one in nine patients had an unsatisfactory appearance, and problems can occur at the ear where the graft is taken.
• Retrospective, single centre, no comparison group, and the abstract does not state how long patients were followed.

Why this paper matters

Choice of graft material is the central practical decision in augmentation rhinoplasty, weighing supply, shaping and donor site cost. Keeping the perichondrium attached is a way to make a limited, curved cartilage source behave like a sheet. Durability over years and comparison with diced cartilage wrapped in fascia are not addressed.

Terms

• Conchal cartilage: cartilage from the bowl-shaped hollow of the outer ear.
• Perichondrium: the thin membrane covering cartilage that supplies it with nutrients.
• Diced cartilage: cartilage chopped into small pieces so it moulds smoothly.
• Radix: the root of the nose, the deepest point of the bridge between the eyes.
• Fascia lata: a sheet of strong connective tissue from the outer thigh.