Costal cartilage graft for treatment of empty nose – a new technic
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The purpose of this study is to describe a technique for treatment of empty nose syndrome using costal cartilage and insert the graft through an oral approach. This review aims to discuss the proposed pathophysiology of Empty Nose Syndrome (ENS), evaluate the role of validated diagnostic tools in its diagnosis, and review medical and surgical treatment strategies for affected patients. Recent findings suggest that aside from a reduction in nasal turbinate size, impaired trigeminal nerve function may also contribute to the pathophysiology of ENS.Keywords:
Costal cartilage
Microtia
Costal cartilage
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Purpose of review In revision or posttraumatic rhinoplasty, the quantity and quality of septal cartilage available for grafting is often deficient and auricular cartilage often provides insufficient strength for structural nasal reconstruction. Accordingly, rib cartilage serves as a reliable, abundant source of cartilage for grafting. However, the various sources of rib cartilage carry respective benefits and weaknesses. This review examines recent studies, novel applications and a comparison of the primary sources of rib cartilage, including autologous cartilage, irradiated cadaveric rib and fresh frozen cadaveric cartilage. Recent findings Options for rib cartilage include autologous, irradiated cadaveric rib, and more recently, reports on fresh frozen cadaveric cartilage. Studies continue to conclude that autologous and irradiated donor cartilage carry equivalent results, have similar rates of complication and have a comparable cost profile. Summary Regardless of the source, rib cartilage plays an important role in structural rhinoplasty, especially in revision cases. Although the risks, benefits and long-term results of autologous and radiated homologous cartilage have been evaluated in observational studies, fresh frozen rib cartilage will need further follow up before widespread use, although preliminary literature shows promise.
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The authors present long-term results of using costal and alar allo-cartilages for repairing defects of the cartilage part of nasal ridge. Transplantation of the costal allo-cartilage to 362 patients entailed cartilage deformations in 50, inflammation in 34 and resolution of the cartilage in 26 patients. Transplantation of alar cartilage brought resolution and deformation in 10 and 7 cases of 276 transplantations, respectively, in the absence of inflammation. Moreover, the latter material provides better cosmetic results.
Costal cartilage
Nasal cartilages
Nasal dorsum
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Microtia is a congenital aplasia of the auricular cartilage. Conventionally, autologous costal cartilage grafts are collected and shaped for transplantation. However, in this method, excessive invasion occurs due to limitations in the costal cartilage collection. Due to deformation over time after transplantation of the shaped graft, problems with long-term morphological maintenance exist. Additionally, the lack of elasticity with costal cartilage grafts is worth mentioning, as costal cartilage is a type of hyaline cartilage. Medical plastic materials have been transplanted as alternatives to costal cartilage, but transplant rejection and deformation over time are inevitable. It is imperative to create tissues for transplantation using cells of biological origin. Hence, cartilage tissues were developed using a biodegradable scaffold material. However, such materials suffer from transplant rejection and biodegradation, causing the transplanted cartilage tissue to deform due to a lack of elasticity. To address this problem, we established a method for creating elastic cartilage tissue for transplantation with autologous cells without using scaffold materials. Chondrocyte progenitor cells were collected from perichondrial tissue of the ear cartilage. By using a multilayer culture and a three-dimensional rotating suspension culture vessel system, we succeeded in creating scaffold-free elastic cartilage from cartilage progenitor cells.
Costal cartilage
Hyaline cartilage
Microtia
Perichondrium
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Costal cartilage is commonly employed as a dorsal implant in Asian rhinoplasty. To achieve better outcomes, it is important to know which types of costal cartilage are most appropriate for dorsal augmentation.The authors investigated how various forms of costal cartilage affect the surrounding tissues and their resorption over time, as well as their clinical appearance, using histomorphological analysis.Cartilage samples were collected from the anterior chest wall of 10 rabbits. Four forms of cartilage-2-mm solid block, 1-mm solid block, diced, and crushed-were prepared and inserted into the subcutaneous tissue pockets of the nasal dorsum of each rabbit. The animals were killed 3 and 6 months later, and graft specimens were examined.Histomorphological analysis revealed important findings of the cartilage and surrounding tissues. The thickness of thick cartilage significantly decreased over time, but the thickness of thin cartilage did not significantly change (P = 0.038). Additionally, the thick cartilages showed a lower degree of vascularization than the thin cartilages (P < 0.001). A comparison of the cartilage forms revealed that the diced cartilages had better chondrocyte survival than the solid block cartilages (P < 0.001). Fat tissues were prominently observed surrounding the diced cartilages at 3 months (P = 0.01), and fibrosis was more prominently observed in the crushed cartilage than in the other types of cartilages (P = 0.04 and P = 0.005 at 3 and 6 months, respectively).This study revealed differences in resorption depending on the thickness of the costal cartilage in rabbits. Among the various forms of costal cartilages, diced and thin solid-block cartilage were the best option for dorsal augmentation when considering long-term graft survival.
Costal cartilage
Subcutaneous tissue
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Costal cartilage
Auricle
Microtia
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THE NEED to develop an effective technique for the permanent alteration of the shape of cartilage is apparent to all of us who do reconstructive surgery. Gibson and Davis,1in a study on the behavior pattern of costal cartilage, showed the presence of interlocking stresses in human costal cartilage in a state of balance, with the outer layer in a state of tension and the inner layer in a state of compression. They also correlated the stress pattern and the cellular arrangement in costal cartilage, demonstrating ways of preventing warping by using balanced cross sections to shape the graft, changing the relationship of these forces upon the cartilage. Frye2showed that thin cartilage as well as cartilage with better cell differentiation, as determined by the arrangement of the cells in the cartilage, tends to deform more readily when acted upon by an outside force. He demonstrated distortion of
Costal cartilage
Tension (geology)
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Cartilage deficiency has clinical relevance in the form of septal perforations, malignancy-related or traumatic tissue defects. The limited amount of available nasal cartilage as well as its bradytrophy present evident challenges for surgical reconstruction. Moreover, the use of auricular or costal cartilage grafts is associated with secondary defects and structural limitations of heterotopic grafts.
Costal cartilage
Nasal cartilages
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Since autologous cartilage is a good transplant material, it is widely used in various fields of clinical medicine. In this study, we collected clinical specimens obtained at different numbers of years after transplantation and used histologic staining to explore the post-transplantation changes in auricular cartilage and costal cartilage. A retrospective analysis was performed on patients who underwent primary autologous cartilage rhinoplasty and secondary rhinoplasty from 2017 to 2021, and the remaining autologous cartilage tissue after surgery was used for histologic testing. As time progressed after transplantation, the density of costal chondrocytes decreased first and then increased, while the secretion of type II collagen and extracellular matrix both decreased slightly. There was a clear boundary between the cartilage tissue and the surrounding connective tissue, and there was no ingrowth of blood vessels in the cartilage. Auricular cartilage showed a decrease in the integrity of the matrix edge. Moreover, local fibrosis was visible, and vascular ingrowth was observed at the edge of the cartilage. The content of type II collagen first increased and then decreased, and the cell secretion function was lower than that of normal chondrocytes. The results of the study suggest that the histologic outcome of elastic cartilage after transplantation is significantly different from that of hyaline cartilage. Moreover, costal cartilage was more stable than auricular cartilage after transplantation.
Costal cartilage
Hyaline cartilage
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Abstract Cartilage is a strong and flexible connective tissue that has many forms and functions in our body. While cartilage exhibits some forms of limited repair, for the most part, it is not particularly regenerative. Thus, in situations where patients require cartilage reconstruction, surgeons may use autografts to replace missing or damaged tissue. Cartilage tissues from different regions of the body exhibit histological differences and are in limited supply. Thus, it is important to characterize these differences to determine the most appropriate autograft source. In the case of microtia, a congenital deformity where the pinna is underdeveloped, reconstruction commonly utilizes cartilage sourced from a patient's own costal cartilage. This presents a potential morbidity risk. In this study, we evaluate the histological characteristics of microtia cartilage compared with normal auricular and costal cartilage obtained from human patients undergoing surgical resection. Histochemistry was used to evaluate cellularity, lipid content, and ECM content. Using a Bayesian statistical approach, we determined that while costal cartilage is the standard tissue donor, the microanatomy of microtia cartilage more closely reflects normal auricular cartilage than costal cartilage. Therefore, microtia cartilage may serve as an additional reservoir for cartilage during reconstruction.
Microtia
Costal cartilage
Pinna
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