Diced Cartilage Graft for Revision Rhinoplasty in a 64-year-old Cleft Patient: A Case Report

Overview

People born with a cleft lip and palate often need nasal revision, and the authors' center has used finely chopped cartilage rather than a single solid block for this since 2003. This report describes one patient in whom the rib cartilage turned out to be calcified, meaning partly turned to bone, which affects how easily it can be diced and shaped.

Sections of note

• Single patient: a 64-year-old woman with a right unilateral complete cleft lip and palate deformity presenting for secondary revision.
• Central-pattern rib calcification was found during the operation.
• Pure diced cartilage graft has been the center's technique of choice for cleft revision rhinoplasty since 2003.
• Stated advantages of dicing over a solid onlay block: minimal risk of warping, technical simplicity, and shape adjustable by manual massage for up to 3 weeks after surgery.
• Calcification of costal cartilage is identified by the authors as a real concern for surgeons.
• Outcomes, operative details, and limitations are discussed in the full report; the abstract gives no follow-up length or outcome measurement.

What it means for a patient

• A solid piece of carved cartilage can bend over time; dicing it into small pieces removes that risk.
• The three-week window in which the shape can be adjusted by pressing on the outside is unusual among grafting methods.
• Rib cartilage hardens with age, so an older patient's rib may not be usable in the same way.
• This is one patient with no comparison group and no stated follow-up, so it cannot show how often the technique succeeds.

Why this paper matters

Cleft nasal deformity typically requires multiple operations across a lifetime, and by later decades the rib donor site may be calcified. This case documents that problem. A single case does not establish how well diced cartilage performs in calcified ribs generally.

Terms

• Diced cartilage graft: Cartilage cut into very small pieces and placed as a mass rather than as one block.
• Warping: The gradual bending of a solid carved cartilage graft after implantation.
• Costal cartilage: The cartilage joining the ribs to the breastbone, a common graft source.
• Calcification: Hardening of tissue by calcium deposits, making cartilage bone-like.
• Cleft lip and palate: A birth difference where the lip and roof of the mouth do not fully join.