Free Diced Cartilage: A New Application of Diced Cartilage Grafts in Primary and Secondary Rhinoplasty

Overview

Irregularities of the bridge after hump reduction account for a substantial share of revision rhinoplasties. The authors developed a method of finely dicing cartilage and placing it precisely as a paste, without wrapping it in fascia. This retrospective analysis compared three ways of covering or augmenting the bridge.

Sections of note

• Retrospective analysis of multisurgeon consecutive open approach rhinoplasties from January to December 2014 at a single center.
• Cartilage was harvested from septum, rib, or ear and used for smoothing, augmentation, or camouflage.
• Group I: 325 patients with free diced cartilage grafts as the only onlay.
• Group II: 73 patients whose dorsal onlay was fascia alone or fascia combined with free diced cartilage.
• Group III: 48 patients receiving dorsal augmentation with the classic diced cartilage in fascia technique.
• 446 patients total across primary and secondary rhinoplasties; observation period 7 months.
• Revision rates for dorsal irregularities: 5.2 percent, 8.2 percent, and 25 percent for groups I, II, and III.

What it means for a patient

• Placing diced cartilage directly, without a fascia wrap, was followed by the lowest revision rate for bridge irregularity in this series.
• The classic wrapped technique had a revision rate roughly five times higher here.
• Limits: retrospective, not randomized, very unequal groups of 325, 73, and 48, one center, and only 7 months of observation.
• Group assignment reflected surgeon choice, so the groups may not have had comparable noses to begin with.

Why this paper matters

Diced cartilage in fascia has been a standard for dorsal augmentation, and this reports a substantially lower revision rate for the unwrapped version. The numbers are large for a rhinoplasty series. The non-randomized design and 7-month window leave the comparison open to selection bias and to late changes.

Terms

• Diced cartilage graft: Cartilage cut into very small pieces and placed as a mass.
• Free diced cartilage: Diced cartilage placed directly, without a fascia wrapping.
• Diced cartilage in fascia: Diced cartilage wrapped in a fascia sleeve before placement.
• Fascia: A thin sheet of fibrous tissue used to wrap or camouflage grafts.
• Onlay: A graft laid on top of a structure to add height or smooth contour.