Download PDF
Facial Plast Surg 2023; 39(06): 679-685
DOI: 10.1055/s-0042-1749408
Original Research

Histology and Long-term Clinical Outcome of Crushed Cartilage with Double-layer Gelatin Sponge Membrane for Dorsum Refinement in Primary Rhinoplasty

Riccardo Nocini
1   Unit of Oral and Maxillofacial Surgery, Department of Surgery, Dentistry, Paediarics and Gynaecology, University of Verona, Verona, Italy
,
Maryam Abdulraheem
2   Department of Otolaryngology, Ambulatory Care Center (ACC), Hamad Medical Corporation (HMC), Doha, Qatar
,
Pier-Francesco Galzignato
1   Unit of Oral and Maxillofacial Surgery, Department of Surgery, Dentistry, Paediarics and Gynaecology, University of Verona, Verona, Italy
,
Jessica Manzini
3   Azienda Ospedaliera Universitaria Integrata (AOUI) Policlinico GB Rossi, Verona, Italy
,
Paolo Bernardi
4   Unit of Human Anatomy, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
,
Giamaica Conti
4   Unit of Human Anatomy, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
,
Andrea Sbarbati
4   Unit of Human Anatomy, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
,
Salvatore Chirumbolo 
4   Unit of Human Anatomy, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
,
Dario Bertossi
5   Unit of Otorhinolaryngology, Department of Surgery, Dentistry, Paediarics and Gynaecology, University of Verona, Verona, Italy
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

This article demonstrates the ability to use autologous crushed cartilage grafts in rhinoplasty with rapid recovery and optimal nasal functionality without any tissue damage and allows its rapid rejuvenation. Eligible patients underwent primary rhinoplasty using autologous crushed cartilage graft followed by microscopy imaging of the grafted tissue after recovery. Tissue and cytological analysis using optical microscopy, transmission electronic microscopy (TEM), and scanning electronic microscopy (SEM) showed complete viability of chondrocytes, formation of new collagen fibers, neo-perichondrium, neo-angiogenesis, and exhibiting optimal aesthetic outcome. The surgical approach is easy to perform, feasible, and less time-consuming, with excellent tissue rejuvenation and rapid recovery.

Keywords

crushed cartilage - histology - rhinoplasty - nasal dorsum - surgery

Ethical Approval

All procedures performed involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.




Publication History

Article published online:
15 February 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Ho OYM, Ku PKM, Tong MCF. Rhinoplasty outcomes and trends. Curr Opin Otolaryngol Head Neck Surg 2019; 27 (04) 280-286
    Google Scholar
  • 2 Jang YJ, Moon BJ. State of the art in augmentation rhinoplasty: implant or graft?. Curr Opin Otolaryngol Head Neck Surg 2012; 20 (04) 280-286
    CrossrefPubMedGoogle Scholar
  • 3 Young K, Rowe-Jones J. Current approaches to septal saddle nose reconstruction using autografts. Curr Opin Otolaryngol Head Neck Surg 2011; 19 (04) 276-282
    CrossrefPubMedGoogle Scholar
  • 4 Chang JS, Becker SS, Park SS. Nasal reconstruction: the state of the art. Curr Opin Otolaryngol Head Neck Surg 2004; 12 (04) 336-343
    CrossrefPubMedGoogle Scholar
  • 5 Bayat M, Bahrami N, Mesgari H. Rhinoplasty with fillers and fat grafting. Oral Maxillofac Surg Clin North Am 2021; 33 (01) 83-110
    CrossrefPubMedGoogle Scholar
  • 6 Gowda AU, Pourtaheri N, Park KE. et al. Crushed cartilage and autologous fat for dorsal nasal refinement. Aesthetic Plast Surg 2021; 45 (05) 2271-2277
    CrossrefPubMedGoogle Scholar
  • 7 Lee HJ, Bukhari S, Jang YJ. Dorsal augmentation using crushed autologous costal cartilage in rhinoplasty. Laryngoscope 2021; 131 (07) E2181-E2187
    PubMedGoogle Scholar
  • 8 Kumral TL, Uyar Y, Yıldırım G, Berkiten G, Atar Y, Ataç E. The development of dorsal nasal cyst formation after rhinoplasty and its reconstruction with conchal cartilage. Case Rep Otolaryngol 2014; 2014: 928715
    PubMedGoogle Scholar
  • 9 Boccieri A, Marianetti TM, Pascali M. Crushed cartilage: a rescue procedure in rhinoplasty. J Craniofac Surg 2018; 29 (03) 614-617
    CrossrefPubMedGoogle Scholar
  • 10 Arslan F, Yildiz CA. A practical suggestion for prepare dorsal onlay graft. J Craniofac Surg 2018; 29 (04) e344-e345
    CrossrefPubMedGoogle Scholar
  • 11 Collawn SS, Fix RJ, Moore JR, Vasconez LO. Nasal cartilage grafts: more than a decade of experience. Plast Reconstr Surg 1997; 100 (06) 1547-1552
    CrossrefPubMedGoogle Scholar
  • 12 Hamra ST. Crushed cartilage grafts over alar dome reduction in open rhinoplasty. Plast Reconstr Surg 1993; 92 (02) 352-356
    CrossrefPubMedGoogle Scholar
  • 13 Hizal E, Buyuklu F, Ozer O, Cakmak O. Effects of different levels of crushing on the viability of rabbit costal and nasal septal cartilages. Plast Reconstr Surg 2011; 128 (05) 1045-1051
    CrossrefPubMedGoogle Scholar
  • 14 Cakmak O, Altintas H. A classification for degree of crushed cartilage. Arch Facial Plast Surg 2010; 12 (06) 435-436
    CrossrefPubMedGoogle Scholar
  • 15 Ortiz-Monasterio F, Olmedo A, Oscoy LO. The use of cartilage grafts in primary aesthetic rhinoplasty. Plast Reconstr Surg 1981; 67 (05) 597-605
    CrossrefPubMedGoogle Scholar
  • 16 Sheen JH. The ideal dorsal graft: a continuing quest. Plast Reconstr Surg 1998; 102 (07) 2490-2493
    CrossrefPubMedGoogle Scholar
  • 17 Lovice DB, Mingrone MD, Toriumi DM. Grafts amd implants in rhinoplasty and nasal reconstruction. Otolaryngol Clin North Am 1999; 32 (01) 113-141
    CrossrefPubMedGoogle Scholar
  • 18 Sachs ME. Mastering Revision Rhinoplasty. New York, NY: Springer; 2006
    Google Scholar
  • 19 Cakmak O, Buyuklu F. Crushed cartilage grafts for concealing irregularities in rhinoplasty. Arch Facial Plast Surg 2007; 9 (05) 352-357
    CrossrefPubMedGoogle Scholar
  • 20 Adamson PA. Grafts in rhinoplasty: autogenous grafts are superior to alloplastic. Arch Otolaryngol Head Neck Surg 2000; 126 (04) 561-562
    CrossrefPubMedGoogle Scholar
  • 21 Romo III T, McLaughlin LA, Levine JM, Sclafani AP. Nasal implants: autogenous, semisynthetic, and synthetic. Facial Plast Surg Clin North Am 2002; 10 (02) 155-166
    CrossrefPubMedGoogle Scholar
  • 22 Gunter JP, Landecker A, Cochran CS. Frequently used grafts in rhinoplasty: nomenclature and analysis. Plast Reconstr Surg 2006; 118 (01) 14e-29e
    CrossrefPubMedGoogle Scholar
  • 23 Kim HS, Park SS, Kim MH, Kim MS, Kim SK, Lee KC. Problems associated with alloplastic materials in rhinoplasty. Yonsei Med J 2014; 55 (06) 1617-1623
    CrossrefPubMedGoogle Scholar
  • 24 Sclafani AP, Thomas JR, Cox AJ, Cooper MH. Clinical and histologic response of subcutaneous expanded polytetrafluoroethylene (Gore-Tex) and porous high-density polyethylene (Medpor) implants to acute and early infection. Arch Otolaryngol Head Neck Surg 1997; 123 (03) 328-336
    CrossrefPubMedGoogle Scholar
  • 25 Deva AK, Merten S, Chang L. Silicone in nasal augmentation rhinoplasty: a decade of clinical experience. Plast Reconstr Surg 1998; 102 (04) 1230-1237
    CrossrefPubMedGoogle Scholar
  • 26 Conrad K, Torgenson CS, Gilman GS. Application of GORE-TEX implants in rhinoplasty reexamined after 17 years. Arch Facial Plast Surg 2008; 10: 224-231
    CrossrefPubMedGoogle Scholar
  • 27 Erol OO. The Turkish delight: a pliable graft for rhinoplasty. Plast Reconstr Surg 2000; 105 (06) 2229-2241 , discussion 2242–2243
    CrossrefPubMedGoogle Scholar
  • 28 Buyuklu F, Cakmak O. Histological analysis of human diced cartilage grafts. Plast Reconstr Surg 2007; 120 (01) 348-349
    CrossrefPubMedGoogle Scholar
  • 29 Yilmaz S, Erçöçen AR, Can Z, Yenidünya S, Edali N, Yormuk E. Viability of diced, crushed cartilage grafts and the effects of Surgicel (oxidized regenerated cellulose) on cartilage grafts. Plast Reconstr Surg 2001; 108 (04) 1054-1060 , discussion 1061–1062
    CrossrefPubMedGoogle Scholar
  • 30 Brenner KA, McConnell MP, Evans GR, Calvert JW. Survival of diced cartilage grafts: an experimental study. Plast Reconstr Surg 2006; 117 (01) 105-115
    CrossrefPubMedGoogle Scholar
  • 31 Kelly MH, Bulstrode NW, Waterhouse N. Versatility of diced cartilage-fascia grafts in dorsal nasal augmentation. Plast Reconstr Surg 2007; 120 (06) 1654-1659
    CrossrefPubMedGoogle Scholar
  • 32 Guerrerosantos J, Trabanino C, Guerrerosantos F. Multifragmented cartilage wrapped with fascia in augmentation rhinoplasty. Plast Reconstr Surg 2006; 117 (03) 804-812 , discussion 813–816
    CrossrefPubMedGoogle Scholar
  • 33 Calvert JW, Brenner K, DaCosta-Iyer M, Evans GR, Daniel RK. Histological analysis of human diced cartilage grafts. Plast Reconstr Surg 2006; 118 (01) 230-236
    CrossrefPubMedGoogle Scholar
  • 34 Daniel RK. Diced cartilage grafts in rhinoplasty surgery: current techniques and applications. Plast Reconstr Surg 2008; 122 (06) 1883-1891
    CrossrefPubMedGoogle Scholar
  • 35 Bullocks JM, Echo A, Guerra G, Stal S, Yuksel E. A novel autologous scaffold for diced-cartilage grafts in dorsal augmentation rhinoplasty. Aesthetic Plast Surg 2011; 35 (04) 569-579
    CrossrefPubMedGoogle Scholar
  • 36 Elahi MM, Jackson IT, Moreira-Gonzalez A, Yamini D. Nasal augmentation with Surgicel-wrapped diced cartilage: a review of 67 consecutive cases. Plast Reconstr Surg 2003; 111 (03) 1309-1318 , discussion 1319–1321
    CrossrefPubMedGoogle Scholar
  • 37 Cakmak O, Buyuklu F, Yilmaz Z, Sahin FI, Tarhan E, Ozluoglu LN. Viability of cultured human nasal septum chondrocytes after crushing. Arch Facial Plast Surg 2005; 7 (06) 406-409
    CrossrefPubMedGoogle Scholar
  • 38 Bujía J. Determination of the viability of crushed cartilage grafts: clinical implications for wound healing in nasal surgery. Ann Plast Surg 1994; 32 (03) 261-265
    CrossrefPubMedGoogle Scholar
  • 39 Kayabasoglu G, Ozbek E, Yanar S. et al. The comparison of the viability of crushed, morselized and diced cartilage grafts: a confocal microscopic study. Eur Arch Otorhinolaryngol 2015; 272 (05) 1135-1142
    CrossrefPubMedGoogle Scholar
  • 40 Gordon CR, Alghoul M, Goldberg JS, Habal MB, Papay F. Diced cartilage grafts wrapped in AlloDerm for dorsal nasal augmentation. J Craniofac Surg 2011; 22 (04) 1196-1199
    CrossrefPubMedGoogle Scholar
  • 41 Petersen JK, Krogsgaard J, Nielsen KM, Nørgaard EB. A comparison between 2 absorbable hemostatic agents: gelatin sponge (Spongostan) and oxidized regenerated cellulose (Surgicel). Int J Oral Surg 1984; 13 (05) 406-410
    CrossrefPubMedGoogle Scholar
  • 42 Bleys RL, Popko M, De Groot JW, Huizing EH. Histological structure of the nasal cartilages and their perichondrial envelope. II. The perichondrial envelope of the septal and lobular cartilage. Rhinology 2007; 45 (02) 153-157
    PubMedGoogle Scholar
  • 43 Duynstee ML, Verwoerd-Verhoef HL, Verwoerd CD, Van Osch GJ. The dual role of perichondrium in cartilage wound healing. Plast Reconstr Surg 2002; 110 (04) 1073-1079
    PubMedGoogle Scholar
  • 44 Mo JH, Lee DJ, Chung PS, Chung YJ. Regenerative and proliferative activities of chondrocyte based on the degree of perichondrial injury in rabbit auricular cartilage. Eur Arch Otorhinolaryngol 2014; 271 (06) 1573-1580
    CrossrefPubMedGoogle Scholar