Ultra Diced Cartilage Graft in Rhinoplasty: A Fine Tool

Dr. Süleyman Taş presents the ultra diced cartilage graft technique as a fast, reproducible approach for smoothing or augmenting the nasal dorsum and compares it with conventional free diced cartilage grafting.

Publication Overview

This scientific publication by Süleyman Taş, M.D., from TAŞ Aesthetic Surgery Clinic examines the use of ultra diced cartilage grafting in rhinoplasty. The work was received on December 30, 2019, accepted on September 11, 2020, and published in Plastic and Reconstructive Surgery in 2021. The study addresses a practical problem in dorsal refinement: conventional free diced cartilage can require substantial preparation time and may remain visible, especially beneath thin skin.

The stated objective was to present the ultra diced cartilage graft, explain how it is prepared, address the limitations associated with free diced cartilage, and compare clinical outcomes between the two approaches. The clinical question was therapeutic and the publication assigns Level III evidence.

Background and Rationale

Dorsal hump reduction and reconstruction are central components of many rhinoplasty operations. Even after careful hump reduction and reconstruction with spreader grafts or flaps, dorsal asymmetries and irregularities may appear because normal anatomy has been altered. In other cases, particularly ethnic and revision rhinoplasty, augmentation of the radix or dorsum may be necessary.

Diced cartilage has long been used as a pliable autologous graft. Earlier methods used Surgicel or temporal fascia as a scaffold, while later literature examined the use of free diced cartilage. The study notes three recurring concerns: the need to keep diced cartilage together and shapeable, the time and possible biologic implications of a scaffold, and graft visibility under thin skin. Very small cartilage particles have been recommended to reduce visibility, but preparing them manually can be time-consuming.

Patients and Methods

The study retrospectively evaluated primary and revision rhinoplasty patients operated on between April 2015 and December 2018. Group 1 consisted of 113 patients treated with free diced cartilage between April 2015 and December 2016. Group 2 consisted of 104 patients treated with the ultra diced cartilage technique between January 2017 and December 2018. Both techniques were used to smooth the dorsum or augment the radix and dorsum.

Standard photographs were obtained during follow-up. Immediate postoperative photographs and one-year photographs were reviewed by two blinded independent plastic surgeons for graft visibility and resorption. Scoring ranged from 0 for graft resorption, to 1 for graft visibility, and 2 for a smooth dorsum. Palpation testing was performed at the one-year visit to assess dorsal irregularities. A validated Rhinoplasty Outcome Evaluation questionnaire assessed social, functional, and aesthetic satisfaction. Chi-square testing was used for statistical analysis.

Ultra Diced Cartilage Technique

All operations were performed under general anesthesia with a closed approach. Cartilage remnants from septal surgery, lower lateral cartilage trimming, upper lateral cartilage, conchal cartilage, or rib cartilage in revision cases were collected. In the free diced cartilage group, the material was carefully cut into pieces smaller than 0.2 mm using a No. 15 blade.

For the ultra diced technique, cartilage was first cut roughly into 4–5 mm pieces to fit inside an insulin syringe. A No. 15 blade was positioned at the narrow portion of the syringe, and a second prepared syringe was connected. Passing the cartilage repeatedly between the syringes chopped the material into a paste-like ultra diced graft. The publication reports that approximately 1 cc could be prepared in less than two minutes and that total cartilage volume decreased from about 1 cc to 0.7 cc as dead space was reduced. The resulting particles were described as smaller than 0.1 mm and cohesive enough to remain together during injection.

Results

A total of 217 patients were initially included. Fifty-eight patients who did not complete one-year follow-up or the outcome questionnaire were excluded from final analysis. Eighty-four patients in the free diced cartilage group and 75 patients in the ultra diced group completed the required follow-up and were analyzed.

Mean follow-up was 22 months in group 1 and 14 months in group 2. Mean preparation time was approximately 10 minutes for free diced cartilage and 2.5 minutes for ultra diced cartilage. The mean amount used for dorsal smoothing was 0.5 cc in group 1 and 0.3 cc in group 2; for augmentation it was 1 cc and 0.7 cc, respectively.

The Rhinoplasty Outcome Evaluation questionnaire showed satisfaction rates of 80.9% in the free diced group and 90.6% in the ultra diced group. Independent photographic assessment showed a smooth dorsum score in 88.6% of group 1 and 96% of group 2, with perfect agreement between evaluators. Palpation identified irregularities in eight patients in group 1 and three in group 2. Revision for irregularity was required in two patients in group 1 and none in group 2. One group 2 patient underwent revision following significant facial trauma rather than graft failure.

Discussion, Limitations and Conclusion

The article argues that very fine, paste-like cartilage may reduce visible contour irregularities while avoiding the additional scaffold required by some diced-cartilage techniques. The proposed syringe-and-blade preparation is presented as a fast method that uses cartilage already available during surgery and therefore adds no implant cost.

The paper also identifies limitations. Histologic support was limited, the experience came from a single surgeon, and broader comparative or multicenter evidence was not available. The author concludes that ultra diced cartilage is an effective, reproducible and highly pliable option for dorsal refinement and augmentation in appropriately selected rhinoplasty cases.

Official Publication and External Source

DOI: https://doi.org/10.1097/PRS.0000000000007794

Journal: Plastic and Reconstructive Surgery. Source-derived educational presentation of Dr. Süleyman Taş’s scientific publication; not individualized medical advice.