Injection of Compressed Diced Cartilage in the Correction of Secondary and Primary Rhinoplasty: A New Technique with 12 Years' Experience

Overview

Diced cartilage can be injected into pockets in the nose without any wrapping material, but the author found results with standard 1-cc syringes partial and incomplete. He designed syringes in two sizes that compress the diced cartilage so it is delivered as one solid mass rather than loose fragments.

Sections of note

• Series of 3,182 rhinoplasties: 2,366 primary, 749 secondary, and 67 cleft lip and nose cases, accrued over 12 years.
• The injected mass is described as a conglutinate mass simulating carved rib cartilage but malleable.
• Complete graft take with a smooth surface in 3,125 patients, 98.2 percent.
• Partial resorption in 21 patients, 0.65 percent, corrected by reinjecting a small amount of diced cartilage.
• Overcorrection in 36 patients, 1.13 percent, treated 1 year later by simple rasping.
• The author states the amount injected is predictable because it is purely cartilage, unlike cartilage wrapped in Surgicel or fascia.
• Claimed advantages over carved cartilage: moldable, time saving, no late show or warping; the injection takes a few minutes.

What it means for a patient

• The graft is placed through a syringe rather than carved and inserted, and can be shaped afterward.
• In this series almost all grafts survived, with under 2 percent needing any touch-up.
• Because the graft contains no wrapping material, the amount placed corresponds directly to the amount of cartilage.
• Limits: a single surgeon's series with no comparison group, no randomization, no stated follow-up length for the whole cohort, and outcomes assessed by the operating surgeon.

Why this paper matters

Diced cartilage wrapped in fascia has been the standard for dorsal augmentation, and this reports very large numbers for an unwrapped injected alternative. The scale is unusual for rhinoplasty. Without a control group the reported take and resorption rates cannot be compared directly with the wrapped technique.

Terms

• Diced cartilage: Cartilage cut into very small pieces and used as a mass rather than a block.
• Graft take: Survival and incorporation of a graft into the surrounding tissue.
• Resorption: Gradual absorption and shrinkage of a graft by the body.
• Warping: Bending of a solid carved cartilage graft after implantation.
• Rasping: Filing down a small excess or irregularity.