Abstract
Diced cartilage has been widely applied in rhinoplasty, especially for segmental dorsal augmentation, with favorable outcomes over time. Various techniques were developed to increase both stability and viability of diced cartilage, including wrappings with non-blood material/blood products and changing the shapes of the diced cartilage, while the optimal technique is inconclusive. This article systematically reviews the current strategies of diced cartilage technique for rhinoplasty in the databases and emphasizes different wrapping materials. Free diced cartilage has a potential risk of gathering in certain regions and causing postoperative irregularities. Among non-blood wrapping materials, Surgicel is now rarely used due to severe foreign body reactions. The obvious drawbacks of fascia are donor site morbidity, inadequate quantity, and time-consuming. Although diced cartilage wrapped in tutoplast-processed fascia lata, AlloDerm, or esterified hyaluronic acid has achieved primary encouraging results, the increased inflammation raised controversies regarding their clinical use. Diced cartilage wrapped with blood products, such as platelet-rich fibrin or concentrated growth factor, achieved long-term reliable aesthetic results, and shaved cartilage and ultra-diced cartilage have recently shown satisfactory clinical outcomes, while further study is still needed.
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References
Lupo G (1997) The history of aesthetic rhinoplasty: special emphasis on the saddle nose. Aesthetic Plast Surg 21(5):309–327
Daniel RK, Sajadian A (2012) Secondary rhinoplasty: management of the overresected dorsum. Facial Plast Surg 28(4):417–426
Young F (1941) Autogenous cartilage grafts. Surgery 10:7
Peer LA (1943) Diced cartilage grafts. Arch Otolaryngol 38:156
Erol OO (2000) The Turkish delight: a pliable graft for rhinoplasty. Plast Reconstr Surg 105(6):2229–2241 (discussion 2242-2223)
Peer LA (1948) Reconstruction of the auricle with diced cartilage grafts in a vitallium ear mold. Plast Reconstr Surg 3:653
Firat C, Gurlek A, Aydin NE (2011) Viability of cartilage grafts in various forms. J Craniofac Surg 22(5):1666–1670
Fatemi MJ, Hasani ME, Rahimian S, Bateni H, Pedram M, Mousavi SJ (2012) Survival of block and fascial-wrapped diced cartilage grafts: an experimental study in rabbits. Ann Plast Surg 69(3):326–330
Topkara A, Ozkan A, Ozcan RH, Oksuz M, Akbulut M (2016) Effect of concentrated growth factor on survival of diced cartilage graft. Aesthet Surg J 36(10):1176–1187
Kreutzer C, Hoehne J, Gubisch W, Rezaeian F, Haack S (2017) Free diced cartilage: a new application of diced cartilage grafts in primary and secondary rhinoplasty. Plast Reconstr Surg 140(3):461–470
Chang CS, Bergeron L, Chen PK (2011) Diced cartilage rhinoplasty technique for cleft lip patients. Cleft Palate Craniofac J 48(6):663–669
Hoehne J, Gubisch W, Kreutzer C, Haack S (2016) Refining the nasal dorsum with free diced cartilage. Facial Plast Surg 32(4):345–350
Lin SI, Hsiao YC, Chang CS, Chen PK, Chen JP, Ueng SH (2016) Histology and long-term stability of diced cartilage graft for revision rhinoplasty in a cleft patient. Plast Reconstr Surg Glob Open 4(6):e763
Erol OO (2017) Injection of compressed diced cartilage in the correction of secondary and primary rhinoplasty: a new technique with 12 years’ experience. Plast Reconstr Surg 140(5):673e–685e
Daniel RK (2008) Diced cartilage grafts in rhinoplasty surgery: current techniques and applications. Plast Reconstr Surg 122(6):1883–1891
Ma JG, Wang KM, Zhao XH, Cai L, Li X (2015) Diced costal cartilage for augmentation rhinoplasty. Chin Med J (Engl) 128(19):2679–2681
Bashir MM, Sohail M, Khan FA, Jan SN, Ansari HH, Nazir U et al (2017) A modified suction-assisted technique of transfer of diced cartilage graft to carrier material and outcome of direct injection of unwrapped diced cartilage in rhinoplasty. J Craniofac Surg 28(4):924–927
Ledo TO, Ramos HHA, Buba CM, Webster G, de Lima JT Jr, de Paiva DL et al (2021) Outcome of free diced cartilage grafts in rhinoplasty: a systematic review. Facial Plast Surg 37(1):117–121
Tas S (2021) Ultra diced cartilage graft in rhinoplasty: a fine tool. Plast Reconstr Surg 147(4):600e–606e
Garofalo R, Pagliari M, D’Ettorre M (2019) Free diced cartilage: tips and tricks of a customized procedure in rhinoplasty. Plast Reconstr Surg Glob Open 7(1):e2018
Gode S, Ozturk A, Berber V, Kismali E (2019) Effect of injectable platelet-rich fibrin on diced cartilage’s viability in rhinoplasty. Facial Plast Surg 35(4):393–396
Yilmaz S, Ercocen AR, Can Z, Yenidunya S, Edali N, Yormuk E (2001) Viability of diced, crushed cartilage grafts and the effects of Surgicel (oxidized regenerated cellulose) on cartilage grafts. Plast Reconstr Surg 108(4):1054–1060
Daniel RK, Calvert JW (2004) Diced cartilage grafts in rhinoplasty surgery. Plast Reconstr Surg 113(7):2156–2171
Keyhan SO, Ramezanzade S, Bohlouli B, Fallahi HR, Shakiba M, Yates J (2021) A meta-analysis of complications associated with autogenous dice cartilage wrapped in fascia used in nasal dorsum augmentation. Aesthet Surg J 41(9):NP1152–NP1165
Cerkes N, Basaran K (2016) Diced cartilage grafts wrapped in rectus abdominis fascia for nasal dorsum augmentation. Plast Reconstr Surg 137(1):43–51
Xavier R (2015) Pectoralis major fascia in rhinoplasty. Aesthetic Plast Surg 39(3):300–305
Brenner KA, McConnell MP, Evans GR, Calvert JW (2006) Survival of diced cartilage grafts: an experimental study. Plast Reconstr Surg 117(1):105–115
Shi Y, Guo R, Hou Q, Hu H, Wang H, Jiang H (2020) The effect of perichondrium on biological and biomechanical properties of molded diced cartilage grafts. Aesthetic Plast Surg 44(2):549–557
Kemaloglu CA, Tekin Y (2014) A comparison of diced cartilage grafts wrapped in perichondrium versus fascia. Aesthetic Plast Surg 38(6):1164–1168
Junqueira LCCJ, Long JA (1986) Basic histology, 5th edn. Lange Medical Publication, California
Jang YJ, Song HM, Yoon YJ, Sykes JM (2009) Combined use of crushed cartilage and processed fascia lata for dorsal augmentation in rhinoplasty for Asians. Laryngoscope 119(6):1088–1092
Gordon CR, Alghoul M, Goldberg JS, Habal MB, Papay F (2011) Diced cartilage grafts wrapped in AlloDerm for dorsal nasal augmentation. J Craniofac Surg 22(4):1196–1199
Kim HK, Chu LS, Kim JW, Park B, Kim MK, Bae TH et al (2011) The viability of diced cartilage grafts wrapped in autogenous fascia and AlloDerm (R) in a rabbit model. J Plast Reconstr Aesthet Surg 64(8):e193-200
Kazikdas KC, Ergur B, Tugyan K, Guneli E, Kaya D, Sahan M (2007) Viability of crushed and diced cartilage grafts wrapped in oxidized regenerated cellulose and esterified hyaluronic acid: an experimental study. Laryngoscope 117(10):1728–1734
Atespare A, Kara H, Ilter E, Boyaci Z, Celik O, Midi A (2016) Utility of cartilage grafts wrapped with amniotic membrane in dorsal nasal augmentation. J Craniofac Surg 27(4):938–942
Oreroglu AR, Cakir B, Akan M (2014) Bone dust and diced cartilage combined with blood glue: a practical technique for dorsum enhancement. Aesthetic Plast Surg 38(1):90–94
Codazzi D, Ortelli L, Robotti E (2014) Diced cartilage combined with warm blood glue for nasal dorsum enhancement. Aesthetic Plast Surg 38(4):822–823
Bullocks JM, Echo A, Guerra G, Stal S, Yuksel E (2011) A novel autologous scaffold for diced-cartilage grafts in dorsal augmentation rhinoplasty. Aesthetic Plast Surg 35(4):569–579
Anitua E (1999) Plasma rich in growth factors: preliminary results of use in the preparation of future sites for implants. Int J Oral Maxillofac Implants 14(4):529–535
Manafi A, Kaviani Far K, Moradi M, Manafi A, Manafi F (2012) Effects of platelet-rich plasma on cartilage grafts in rabbits as an animal model. World J Plast Surg 1(2):91–98
Bulam H, Ayhan S, Yilmaz G, Sezgin B, Sibar S, Tuncer S et al (2015) The effect of subcutaneous platelet-rich plasma injection on viability of auricular cartilage grafts. J Craniofac Surg 26(5):1495–1499
Castro-Govea Y, Ayuzo del Valle S, Cervantes Kardasch V, Phillips Eparza E, Vazquez Costilla O (2015) Diced and crushed cartilage plus autologous fibrin matrix obtained by a simple process for dorsal augmentation of the Mestizo nose. Facial Plast Surg 31(2):164–171
Rodella LF, Favero G, Boninsegna R, Buffoli B, Labanca M, Scari G et al (2011) Growth factors, CD34 positive cells, and fibrin network analysis in concentrated growth factors fraction. Microsc Res Tech 74(8):772–777
Guler I, Billur D, Aydin S, Kocaturk S (2015) Efficacy of platelet-rich fibrin matrix on viability of diced cartilage grafts in a rabbit model. Laryngoscope 125(3):E104-111
Goral A, Aslan C, Bolat Kucukzeybek B, Isik D, Hosnuter M, Durgun M (2016) Platelet-rich fibrin improves the viability of diced cartilage grafts in a rabbit model. Aesthet Surg J 36(4):NP153-162
Bracaglia R, Tambasco D, D’Ettorre M, Gentileschi S (2012) “Nougat graft”: diced cartilage graft plus human fibrin glue for contouring and shaping of the nasal dorsum. Plast Reconstr Surg 130(5):741e–743e
Abdel-Aty Y, Prasad N, Hall SR, Howard BE (2020) Diced cartilage in fibrin glue for dorsal reconstruction as part of staged paramedian forehead flap reconstruction. J Craniofac Surg 32(3):1140–1142
Sage A, Chang AA, Schumacher BL, Sah RL, Watson D (2009) Cartilage outgrowth in fibrin scaffolds. Am J Rhinol Allergy 23(5):486–491
Tasman AJ (2017) Dorsal augmentation-diced cartilage techniques: the diced cartilage glue graft. Facial Plast Surg 33(2):179–188
Stevenson S, Hodgkinson PD (2014) Cartilage putty: a novel use of fibrin glue with morselised cartilage grafts for rhinoplasty surgery. J Plast Reconstr Aesthet Surg 67(11):1502–1507
Boccieri A, Marianetti TM, Pascali M (2018) Crushed cartilage: a rescue procedure in rhinoplasty. J Craniofac Surg 29(3):614–617
Cakmak O, Altintas H (2010) A classification for degree of crushed cartilage. Arch Facial Plast Surg 12(6):435–436
Cakmak O, Bircan S, Buyuklu F, Tuncer I, Dal T, Ozluoglu LN (2005) Viability of crushed and diced cartilage grafts: a study in rabbits. Arch Facial Plast Surg 7(1):21–26
Kayabasoglu G, Ozbek E, Yanar S, Sahin F, Keles ON, Yilmaz MS et al (2015) The comparison of the viability of crushed, morselized and diced cartilage grafts: a confocal microscopic study. Eur Arch Otorhinolaryngol 272(5):1135–1142
Mutlu V (2019) A novel surgical technique: Crushed septal cartilage graft application in endonasal septoplasty. Auris Nasus Larynx 46(2):218–222
Manafi A, Hamedi ZS, Manafi A, Rajabiani A, Rajaee A, Manafi F (2015) Injectable cartilage shaving: an autologous and long lasting filler material for correction of minor contour deformities in rhinoplasty. World J Plast Surg 4(2):93–100
Trivisonno A, Cohen SR, Magalon G, Magalon J, Sterodimas A, Pascali M et al (2019) Fluid cartilage as new autologous biomaterial in the treatment of minor nose defects: clinical and microscopic difference amongst diced, crushed, and fluid cartilage. Materials (Basel) 12(7):1062
Santos M, Ribeiro A, Sousa CAE, Santos J, Dourado N, Amarante J et al (2020) Shaved cartilage gel versus diced cartilage on final dorsal camouflage: prospective study of 200 patients. Facial Plast Surg Aesthet Med 23(3):164–71
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This study was funded by the Foundation of the Chinese Academy of Medical Sciences-Plastic Surgery Hospital (3060120043).
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Dong, W., Han, R. & Fan, F. Diced Cartilage Techniques in Rhinoplasty. Aesth Plast Surg 46, 1369–1377 (2022). https://doi.org/10.1007/s00266-021-02628-2
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DOI: https://doi.org/10.1007/s00266-021-02628-2