Ultradiced Rib Cartilage Graft Without Wrapping for Augmentation Rhinoplasty

Abstract

Diced rib cartilage grafting, first described by Erol et al., has been being used extensively in the world due to the advantage of dicing. However, the traditional harvesting technique of rib cartilage results in a long scar, possible pneumothorax, and severe pain due to extensive dissection and resection of some rib cartilage. Therefore, a scooping technique has been developed for the harvesting of diced rib cartilage, the diced cartilage graft inserted through an extended endonasal approach of rhinoplasty. Using a small incision on the chest (1.2–2.0 cm), cartilage was harvested from just the outer layer of costal cartilage with a carving instrument. Harvested costal cartilage was diced into microparticulates about 0.2–0.5 mm² with a cartilage dicer. These diced particulates were put into a modified 1-cc syringe and inserted into the nasal dorsal framework in each patient through the extended endonasal approach. Incision length was 1.2–2.0 cm (average 1.4 cm), the average harvesting time of cartilage was 12 min (9–17 min), the average amount of harvested cartilage was 1.35 cc(0.5–2.3 cc), and the average volume of inserted cartilage was 1.13 cc. Asian rhinoplastic surgeons are accustomed to using alloplastic materials. However, despite ease of use, alloplastic materials are associated with risk of severe complications. With autogenous diced cartilage graft, the serious complications of alloplastic implants might be avoided. The authors propose a simple, short, and safe technique at the donor site of the chest and involving no columellar scar for rhinoplasty; this technique is an autogenous-friendly concept for rhinoplastic surgeons.