Comparison of Free Diced and Multiple Toothpick-Shaped Costal Cartilage Injection Techniques for Augmentation Rhinoplasty

Overview

The free diced costal cartilage injection technique has long been used to build up the nasal bridge. To reduce contour irregularities and graft movement, the authors developed a technique using multiple toothpick shaped pieces instead. This retrospective comparative study assessed the new method against the established one in patients treated at a plastic surgery hospital between July 2014 and May 2020.

Sections of note

• Retrospective analysis of 51 patients; the journal assigns level of evidence IV.
• The free diced group had 30 patients, 58.82 percent; the toothpick shaped group had 21, 41.18 percent.
• Apart from follow up period, there were no significant differences in age, sex, preoperative bridge deformity or previous rhinoplasty history between groups.
• Postoperative patient satisfaction was similar between the two groups.
• Complications were similar between the two groups.
• Revision rates were similar between the two groups.
• The authors state both techniques are relatively easy and quick, with concealed scarring and minimal swelling afterward.
• They state most revisions in either group are easy to perform by simple rasping and reinjection.

What it means for a patient

• Both techniques inject rib cartilage through a small opening rather than placing a solid block, so the scar is hidden.
• The measured outcomes showed no difference between the two shapes.
• The authors nevertheless recommend the new technique based on their impression of wider indication and fewer irregularities, which the data did not demonstrate.
• Fifty one patients split unevenly between groups, with different follow up periods, is limited evidence.

Why this paper matters

Injecting cartilage avoids an open bridge procedure but risks the pieces migrating or leaving visible lumps, which is what the shape change is meant to address. This study compares the two directly. It found no measurable advantage, which the authors' conclusion does not fully reflect.

Terms

• Free diced cartilage: cartilage cut into small pieces and placed without a wrapping.
• Costal cartilage: cartilage taken from the rib.
• Augmentation rhinoplasty: surgery that builds the nose up rather than reducing it.
• Graft displacement: a graft shifting out of its intended position.
• Rasping: filing down a graft or bone surface to smooth it.