Using platelet-rich fibrin scaffolds with diced cartilage graft in the treatment of empty nose syndrome

Empty nose syndrome (ENS) is a rare entity in patients who undergo sinonasal surgery due to over-resection of the turbinate. This syndrome leads to debilitating symptoms that include dry nose, painful nasal breathing, paradoxical nasal obstruction, crusting, and sleep disorder. The goal of surgical treatment is to reestablish the volume of the turbinates to rehabilitate the nasal resistance. Endonasal microplasty with cartilage implants on the lateral wall of the nasal cavity is useful for creating the neoturbinate. Here, we present 2 cases that describe the management of empty nose syndrome by endonasal microplasty using platelet-rich fibrin (PRF) scaffolds embedded with a diced cartilage graft. The integration of the PRF scaffolds with diced cartilage efficiently facilitated the reestablishment of the neoturbinate. This autologous biomaterial is suitable for the treatment of ENS.

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 Effect of Perichondrium and Graft Modification on the Viability of Conchal Cartilage Graft: An Experimental Study in Rabbit

Objective: Cartilage grafts are widely used in reconstructing nasal deformity for structural and aesthetic purposes. Despite being immunologically privileged, cartilage grafts are susceptible to volume loss with high risk of resorption over time. Therefore, experts opt for cartilage handling modification to resolve this issue through graft dicing, wrapping, or perichondrium preservation. This study will evaluate the effect cartilage graft preparations on graft viability. Design: Single-randomized post-test-only study design. Setting: Animal Hospital at Bogor Agricultural Institute. Participants: Six New Zealand, male, Hycole rabbits. Intervention: Conchal cartilage grafts were retrieved from 6 experimental rabbits and distributed into 3 treatment groups: diced cartilage graft (DC; control), one-sided perichondrium-attached scored cartilage (OPSC), and tube-shaped perichondrium-wrapped diced cartilage (TPDC). Main Outcome Measures: Macroscopic (weight and contour) and microscopic (chondroblast proliferation, graft thickness, apoptotic cells) evaluation through histological measures were recorded on week 12. Statistical analysis was done to compare between groups. Results: Diced cartilage and OPSC groups showed significant weight changes on week 12 ( P < .05) with OPSC presenting with the biggest difference. Diced cartilage and OPSC group showed moderate cell proliferation on week 12 while TPDC displayed most abundant apoptotic cells (5.8%; P < .05). Diced cartilage group had the highest cartilage thickness ratio ( P < .05). Discussion: Bare DC technique promoted graft thickness while perichondrium-attached scored cartilage showed the most abundant chondroblast proliferation and the least apoptotic cells. Perichondrium contributes to enhanced new cartilage formation. Conclusion: Diced cartilage graft is suitable for masking irregularity and volume augmentation, while perichondrium-attached cartilage graft is better for structural support in nasal reconstruction.

A Systematic Review and Meta-Analysis of Complications Associated With Autogenous Diced Cartilage Wrapped in Fascia Used in Nasal Dorsum Augmentation

Background Nasal dorsum augmentation is a highly challenging rhinoplastic procedure. Problems encountered in this surgery, such as residual humps, irregularities, and asymmetry, account for a significant number of revision rhinoplasties. Objectives The aim of this meta-analysis was to assess complication rates and graft harvesting site morbidity and revision rates. Methods We carried out a systematic review of the literature for pertinent materials in PubMed/Medline and Google Scholar up to and including August 2020. In addition, the reference list of included studies was searched manually. The criteria used were those described in the PRISMA Declaration for performing systematic reviews. Results The initial search yielded 236 results. After 3 stages of screening, 16 papers (18 groups) were included in the systematic review and meta-analysis. Our results indicated that the total rates for the complications studied were as follows: graft resorption, 2.52%; insufficient augmentation, 3.93%; deviation (graft displacement), 1.77%; infection, 2.30%; irregularity, 1.36%; supra-tip depression, 1.13%; overcorrection, 3.06%; hematoma at recipient site, 1.36%; and visible bulging of the graft, 2.64%. The total rates for donor site hypertrophic scar and donor site hematoma were 2.64% and 3.58%, respectively. The rate of the revision surgery was 3.03%. Conclusions Current findings suggest the overall complications and revision rates with the use of diced cartilage wrapped in fascia for dorsum augmentation were relatively low and this technique is a reliable treatment choice for patients with primary/secondary dorsum deficiencies. Further studies with larger sample sizes and long-term follow-ups, clearer definitions of complications, and objective measurements are warranted to draw reliable practical conclusions. Level of Evidence: 4