Histology and Long-term Stability of Diced Cartilage Graft for Revision Rhinoplasty in a Cleft Patient

Overview

Diced cartilage is usually wrapped in Surgicel or fascia before it is placed, and pure diced cartilage without any wrapping is less often reported, because of concerns that the pieces scatter, can be felt, or show through the skin. This case report presents what such a graft looked like microscopically after four and a half years in place.

Sections of note

• Case report of one cleft rhinoplasty patient.
• Two pieces of a pure diced cartilage graft placed four and a half years earlier were removed during a revision procedure and sent for microscopic analysis.
• The examination showed small blocks of mature hyaline cartilage embedded in dense fibrous connective tissue.
• Small blood vessel channels were widely scattered through that tissue.
• The cartilage was alive, with chondrocytes present in their lacunae.
• The authors conclude the graft was viable and stable at four and a half years and suggest pure diced cartilage can reliably augment the nasal bridge in cleft rhinoplasty. Advantages and disadvantages of the technique are discussed.

What it means for a patient

• The graft was still living cartilage rather than scar tissue, which is the mechanism by which added height is expected to last.
• The tissue between the pieces had become dense fibrous tissue with a blood supply, which is what appears to hold the pieces together without a wrapping.
• Concerns about scattering, palpability and visibility are the stated reason it is used less often, and this report does not measure how often they occur.
• A single specimen from a single patient at one time point. It shows what happened in one case, not what typically happens.

Why this paper matters

Diced cartilage is widely used but rarely examined after years in place, since doing so requires a revision operation and a willing patient. Direct histological evidence of survival at four and a half years is unusual. Whether the graft held its volume, and how it behaves without a wrapping in general, remains unanswered.

Terms

• Diced cartilage graft: cartilage chopped into small pieces so it moulds smoothly beneath the skin.
• Histology: examination of tissue structure under a microscope.
• Hyaline cartilage: the smooth type of cartilage found in the nose and joints.
• Chondrocyte: a living cartilage cell.
• Surgicel: an absorbable surgical gauze sometimes used to wrap diced cartilage.