Perichondrial Attached Diced Cartilage (PADC), a Novel Graft Material for Nasal Augmentation: 10 Years of Experience

Background Using onlay graft for dorsal augmentation is a challenging procedure. Visibility and warping of grafted cartilages can ruin an otherwise successful operation. A shortage of septal cartilage and rib donor site morbidity compounds the problems of this procedure. Objectives Our objectives were to find an autologous material for dorsal nasal augmentation which does not disperse upon implementation. It also should have minimal resorption, lack of warping and no need for wrapping membrane. Methods In 30 patients, concha cartilage of the ear with attached perichondrium and fascia were removed. The concha cartilage was diced while it was attached to the posterior soft tissue. The purpose was to develop graft material for dorsal augmentation. Results In an average of 19.56 months follow-up, no sign of resorption, infection, inflammation, volume loss, or displacement of the grafted material was noticed. Aesthetically the results were acceptable and most of the patients were satisfied with the outcome. Conclusions Perichondrial attached diced cartilage (PADC) is a new material for the rhinoplasty surgeon to apply in different onlay nasal augmentation procedures in the unduly reduced nasal dorsum. This technique transforms an uneven peculiar-shaped concha cartilage to flexible, versatile, and durable material. The donor site is in the surgical field and easy to access.

The Use of Mastoid Fascia for Dorsal Nasal Augmentation

Background and aim. Dorsal augmentation of the nose is needed after trauma, rhinoplasty or for ethnic reasons. Alloplastic or autogenous materials may be used. In this paper, postauricular mastoid fascia was used for dorsal nasal augmentation. Methods. This study included ten patients who underwent dorsal nasal augmentation. Fascia over mastoid area was taken in all cases and was fixed with Steri-Strips and external nasal splints.Results. All patients were female except one case. Five patients had the operation because of ethnic causes and five patients did the operation due to post traumatic deformity. Donor sites healed uneventfully. Digital photography was taken to assess the grafts and follow up was extended up to 9 months.Conclusions. Mastoid fascia is a reliable method and its donor site is hidden. In addition, it can be a potential site for conchal graft if needed.

Cartilage Scales Embedded in Fibrin Gel

Multiple techniques have been described for dorsal nasal augmentation in rhinoplasty. In this article, we review common surgical techniques for raising the dorsum or eliminating dorsal irregularities, by highlighting inherent advantages and disadvantages of each method. Within the past few years, the use of diced cartilage grafts has become the workhorse in this field of interest. To overcome drawbacks of methods based on diced cartilage, we present a new concept for autologous augmentation, using regenerative medicine protocols. A mix of cartilage scales with cartilage pâté was embedded in platelet-rich fibrin (PRF). Since December 2015, a total of 48 patients were treated with this technique. Based on our preliminary results, cartilage scales in PRF appear to be a promising and reliable alternative to existing procedures for dorsal nasal augmentation.

Augmentation Rhinoplasty with Rib Cartilage Graft

Objective: To investigate the outcome and complications of augmentation rhinoplasty with rib cartilage grafts Methods: Study Design: Retrospective study Setting: Tertiary Government Hospital Participants: Patients who underwent dorsal nasal augmentation with autologous rib cartilage grafts between June 2008 and October 2012. Results: A total of 12 patients (3 male, 9 female) were included in the study. Mean age was 29 years. Seven were cases of primary simple rhinoplasty with 4 cases of revision (previously using alloplastic materials) and one case of trauma. Indications for the procedure were all cosmetic. There was no incidence of infection, both in the donor and recipient sites, warping of the graft, graft extrusion, resorption, pneumothorax, chest wall deformity or prolonged edema. Post-operative pain in the donor site was relieved by oral pain medications. No revision surgery was required. Conclusion: Costal cartilage is a good option for structural support of the nose. In our experience patients have become wary of the complication of allografts and have opted to use autografts. The surgeon’s knowledge of the nasal anatomy as well as his or her experience with autologous grafts plays a major role in avoiding post-operative morbidity. Keywords: Rhinoplasty, rib graft, costal cartilage graft, Southeast Asian nose