The Diced Cartilage Glue Graft for Nasal Augmentation:  Morphometric Evidence of Longevity

Figure 1. A patient with a posttraumatic saddle-nose deformity before (A and C) and 5 months after (B and D) dorsal augmentation. Because significant amounts of septal cartilage had been resected during a previous septoplasty, the diced cartilage glue graft was fashioned using remnants of septal cartilage and auricular cartilage from 1 ear using a 5-mL syringe as a mold (E [measured in centimeters] and F [measured against a Steri-Strip; 3M Nexcare]). The tapering of the graft at the cranial and caudal ends, the concavity of the posterior surface (E), and the convexity of the anterior surface (F) can be seen. Comparing sonographic cross sections of the graft at the sixth postoperative day (G) and 5 months after surgery (H) revealed a reduction in width by 2% and an increase in height by 6%.

Figure 2. A patient with an iatrogenic nasal deformity before (A and C) and 7 months after revision, including smoothing of the cartilaginous dorsum, deprojection of the tip through lateral crural overlay, and augmentation of the supratip with a small diced cartilage glue graft (B and D). The graft was molded in a 1-mL syringe (E), and a sized segment was used for augmenting the supratip only (F).

Figure 3. A patient requesting correction of a posttraumatic septal deformity. Saddling of the cartilaginous dorsum and a nasal hump (A). Because the patient asked for a minor aesthetic improvement without osteotomies, the septum was rotated and the hump was camouflaged with a diced cartilage glue graft, molded in a 2-mL syringe (C), and placed on the periosteum of the radix (D). Four months after surgery (B), the graft measured 7.2 × 1.8 mm (E).

Figure 4. A patient with an iatrogenic cartilaginous pollybeak deformity and an overresected bony dorsum. Preoperative photographs (A and C). Revision included lowering of the cartilaginous dorsum and augmentation of the bony dorsum with a diced cartilage glue (DCG) graft (E and F). The postoperative photographs taken 15 months after revision (B and D) revealed an irregularity that sonographically could be attributed to the insufficiently tapered caudal end of the graft (asterisk on D, E, and F). Hematoxylin-eosin–stained (G) and Elastica-van Gieson–stained (H) sections of the shaved graft irregularity revealed vital cartilage with smooth contours embedded in sparse fibrous tissue. Vital cartilage with several small clones of regenerating chondrocytes showing basophilia (original magnification ×100) (G). Groups of clones are evident in a red collagenous matrix (original magnification ×200) (H). This form and chondrocyte clusters are indicative of cartilage regeneration.

Figure 5. Technique of noncontact sonography. Sonography gel provides acoustic coupling of the straight transducer surface to the curved nasal surface (A). The corresponding sonographic cross section (B) allows identification of the crescent-shaped diced cartilage glue graft (a), the dorsal skin and soft-tissue envelope (b), and the bony dorsum (c), with gel (d) connecting the probe to the nasal dorsum.