Dorsal Augmentation Using a Glued Diced Cartilage Graft Fashioned with a Newly Developed Mold in Asian Rhinoplasty

Overview

Rib cartilage can be used for bridge augmentation as a single block, wrapped in fascia, or diced and glued together. The authors developed a mold to make the glued diced approach more convenient and report their experience with it. Photographs and records were reviewed for satisfaction and complications, and three dimensional scanning was used in a subset to track changes in the graft over time.

Sections of note

• Study of 80 patients; therapeutic level of evidence IV.
• Twenty three patients had three dimensional scanned imaging, measuring bridge width and height at the radix and rhinion.
• Resorption was assessed by comparing the 3 month photograph with the latest photograph, taken at least 1 year after surgery.
• Sixty six patients, 82.5 percent, were satisfied with their outcome.
• Complications occurred in 19 patients, 23.8 percent, and eight revision procedures, 10 percent, were performed.
• One patient had revision surgery because the graft was absorbed.
• Three dimensional scanning showed a significant increase in bridge height at 1 year without widening of the bridge, P less than 0.05.
• There was no significant reduction in bridge height between 3 months and 1 year.

What it means for a patient

• The graft held its height between three months and a year, and only one patient needed revision for absorption.
• Nearly a quarter of patients had some complication and one in ten had further surgery.
• Satisfaction at 82.5 percent means about one patient in six was not satisfied.
• This is a single centre series with no comparison against block or fascia wrapped grafts.

Why this paper matters

Diced cartilage on the bridge is judged on whether it resorbs and whether it spreads sideways, and the mold is intended to control both. This study measures height and width objectively at one year. The 23.8 percent complication rate is the figure to weigh against the stability result.

Terms

• Glued diced cartilage: cartilage cut into small pieces and bonded together, usually with the patient's own blood products.
• Monobloc graft: a single solid piece of cartilage.
• Dorsal augmentation: raising the height of the nasal bridge.
• Radix: the root of the nose between the eyes.
• Rhinion: where the nasal bones meet the cartilage on the bridge.
• Resorption: gradual absorption and loss of graft material by the body.