Dorsal augmentation with diced cartilage enclosed with temporal fascia in secondary endonasal rhinoplasty

Overview

Diced cartilage wrapped in fascia is an established way to build up the bridge in open rhinoplasty, but no data existed for placing it through the closed approach. The authors describe forming the graft as a sealed fascia cylinder and sliding it into a dorsal pocket through nostril incisions in revision cases.

Sections of note

• Retrospective review of 18 closed secondary rhinoplasties, 2008 to 2011; mean age 32.
• Cartilage from septum, rib or ear diced into 0.5 to 1 mm cubes.
• Deep temporal fascia, about 5 by 5 cm, harvested through a single V-shaped incision over the temple, wrapped around a 1 mL syringe, filled with diced cartilage and sutured closed at both ends.
• Graft placed on the dorsum via the endonasal approach.
• Cartilage source: ear in 8, septum plus ear in 6, rib in 4.
• Minimum follow-up 15 months.
• Complications in 3 patients; 1 required surgical revision for contour irregularity.
• No cartilage resorption; smooth dorsal continuity in all patients.

What it means for a patient

• A scooped or uneven bridge from a previous operation can be rebuilt without an external incision, using the patient's own cartilage and fascia.
• In this small series the graft held its volume for over a year.
• Only 18 patients and the authors themselves call the numbers insufficient for firm conclusions; the two non-revised complications are not described.

Why this paper matters

It extends the diced cartilage in fascia technique to closed rhinoplasty, where graft fixation is harder. Larger series and longer follow-up are needed to confirm the absence of resorption.

Terms

• Diced cartilage: cartilage cut into tiny cubes so it can be molded.
• Deep temporal fascia: the tough layer over the temple muscle, used as a wrap for diced cartilage.
• Endonasal approach: rhinoplasty through incisions hidden inside the nostrils.
• Dorsal augmentation: raising the height of the nasal bridge.
• Concha: the bowl-shaped cartilage of the outer ear, a graft source.
• Resorption: the body breaking down and absorbing a graft, causing it to shrink.