Diced Cartilage Techniques in Rhinoplasty

Overview

Diced cartilage is widely used in rhinoplasty, particularly for building up sections of the bridge, with favourable results over time. Various techniques have been developed to increase its stability and cell survival, including wrapping it in blood or non blood materials and changing the shape of the pieces. The review surveys those strategies with emphasis on the wrapping materials.

Sections of note

• Systematic review of published strategies; the journal assigns level of evidence IV.
• Free diced cartilage carries a risk of the pieces gathering in one area and causing irregularities.
• Among non blood wrappings, Surgicel is now rarely used because of severe foreign body reactions.
• Fascia has the drawbacks of a second surgical site, insufficient quantity and being time consuming.
• Diced cartilage wrapped in processed fascia lata, AlloDerm or esterified hyaluronic acid gave encouraging early results but raised controversy over increased inflammation.
• Wrapping in blood products such as platelet rich fibrin or concentrated growth factor achieved long term reliable aesthetic results.
• Shaved cartilage and ultra diced cartilage have recently shown satisfactory outcomes, with further study still needed.
• The authors state the optimal technique remains inconclusive.

What it means for a patient

• The cartilage itself is standard; the debate is over what holds it together and where that material comes from.
• Wrapping in a patient's own blood products avoids a second incision and, per this review, gave the most durable results.
• Several manufactured wrapping materials produced inflammation, which is why their use is contested.
• The review reports no pooled complication rates or comparative statistics in the abstract.

Why this paper matters

Diced cartilage is the default material for bridge augmentation and every surgeon must choose how to contain it. This review maps each option to its known drawback. Without a head to head comparison it cannot say which is best.

Terms

• Diced cartilage: cartilage cut into small pieces so it can be shaped like a paste.
• Fascia: a tough sheet of connective tissue used as a wrapping.
• Surgicel: a manufactured absorbable haemostatic material.
• AlloDerm: processed donor skin with the cells removed.
• Platelet rich fibrin: a concentrate spun from the patient's own blood.
• Foreign body reaction: inflammation caused by the body responding to an implanted material.