A Classification for Degree of Crushed Cartilage

Cakmak, Ozcan; Altintaş, Hande

doi:10.1001/archfacial.2010.80

Cited by 13 publications

(10 citation statements)

References 5 publications

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“…The moderately, significantly and severely crushed grafts demonstrated 50%, 30% and 10% cartilage viability respectively [5]. According to the Cakmak classification system for degrees of crushed cartilage, the injected crushed cartilage in our study is severely crushed, meaning its integrity is totally destroyed [10]. The injected cartilage in our study remained 64% viable on average, with a median of 75%.…”

Section: Discussionmentioning

confidence: 81%

Percutaneous cartilage injection: A prospective animal study on a rabbit model

Beaudoin

Mitchell

Rahal

2013

Journal of Otolaryngology - Head & Neck Surgery

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BackgroundCartilage grafting is a useful technique in nasal reconstruction. Implantation of a whole graft is usually done through an incision. Crushed cartilage can also be used. Injection of cartilage could be an alternative to implantation. The objective of this study is to compare the long-term viability of percutaneously injected crushed auricular cartilage to surgically implanted cartilage in the rabbit.MethodsAuricular cartilage was harvested bilaterally in 10 New Zealand white rabbits. A 1 cm2 cartilage graft was implanted surgically on the upper nasal dorsum. The remaining cartilage was crushed and percutaneously injected on the lower nasal dorsum. Volume and mass of each graft were compared between pre-implantation and after 3 months of observation. A histological study was conducted to evaluate chondrocyte viability and degree of fibrosis on pre and post-implantation cartilage.ResultsMass and volume remained similar for surgically implanted cartilage grafts. Mass and volume diminished by an average of 47% and 40% respectively after 3 months for the injected crushed cartilage grafts. Chondrocyte viability was an average of 25% lower in the injected grafts.ConclusionsCartilage injection is a promising technique that must be refined to increase chondrocyte viability. Developing an appropriate injection apparatus would improve this technique.

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Section: Discussionmentioning

confidence: 81%

Percutaneous cartilage injection: A prospective animal study on a rabbit model

Beaudoin

Mitchell

Rahal

2013

Journal of Otolaryngology - Head & Neck Surgery

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“…This is not time consuming, and can be easily prepared. However, the main issue is that the crushing itself results in damaging the lacuna’s structure, and can result in reducing the chondrocytes’ viability [26].…”

Section: Discussionmentioning

confidence: 99%

Fluid Cartilage as New Autologous Biomaterial in the Treatment of Minor Nose Defects: Clinical and Microscopic Difference Amongst Diced, Crushed, and Fluid Cartilage

et al. 2019

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Developing cartilage constructs with injectability, appropriate matrix composition, and persistent cartilaginous phenotype remains an enduring challenge in cartilage repair. Fourteen patients with minor contour deformity were treated with fluid cartilage filler gently injected as autologous fluid graft in deep planes of defect of the nose that were close to the bone or the cartilage. A computerized tomographic scan control was performed after 12 months. Pearson’s Chi-square test was used to investigate differences in cartilage density between native and newly formed cartilages. The endpoints were the possibility of using fluid cartilage as filler with aesthetic and functional improvement and versatility. Patients were followed up for two years. The constructs of fluid cartilage graft that were injected in the deep plane resulted in a persistent cartilage tissue with appropriate morphology, adequate central nutritional perfusion without central necrosis or ossification, and further augmented nasal dorsum without obvious contraction and deformation. This report demonstrated that fluid cartilage grafts are useful for cartilage regeneration in patients with outcomes of rhinoplasty, internal nasal valve collapse, and minor congenital nose aesthetics deformity.

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“…Residual contour irregularities can be successfully concealed with slightly or moderately crushed autogenous cartilage grafts. The senior author's previous studies 13,14 showed that slight or moderate crush-ing of autogenous cartilage produces an outstanding graft material that is effective in concealing minor irregularities, filling defects, and creating a smoother surface with excellent long-term clinical outcomes and predictable aesthetic results.…”

Section: Discussionmentioning

confidence: 99%

“…The final dorsal irregularities are camouflaged with placement of slightly or moderately crushed cartilage onlay grafts as presented by the senior authors' previous articles. 13,14 Occasionally, if a solid onlay cartilaginous graft is used for deeper defects, its contours are softened by placing small pieces of moderately crushed grafts on or around the solid graft.…”

Section: Typementioning

confidence: 99%

Identifying Septal Support Reconstructions for Saddle Nose Deformity

Cakmak¹,

Emre

Özkurt

2015

JAMA Facial Plast Surg

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The saddle nose deformity is one of the most challenging problems in nasal surgery with a less predictable and reproducible result than other nasal procedures. The main feature of this deformity is loss of septal support with both functional and aesthetic implications. Most reports on saddle nose have focused on aesthetic improvement and neglected the reestablishment of septal support to improve airway. OBJECTIVES To explain how the Cakmak algorithm, an algorithm that describes various fixation techniques and grafts in different types of saddle nose deformities, aids in identifying saddle nose reconstructions that restore supportive nasal framework and provide the aesthetic improvements typically associated with procedures to correct saddle nose deformities. DESIGN, SETTING, AND PARTICIPANTS This algorithm presents septal support reconstruction of patients with saddle nose deformity based on the experience of the senior author in 206 patients with saddle nose deformity. Preoperative examination, intraoperative assessment, reconstruction techniques, graft materials, and patient evaluation of aesthetic success were documented, and 4 different types of saddle nose deformities were defined. MAIN OUTCOMES AND MEASURES The Cakmak algorithm classifies varying degrees of saddle nose deformity from type 0 to type 4 and helps identify the most appropriate surgical procedure to restore the supportive nasal framework and aesthetic dorsum. RESULTS Among the 206 patients, 110 women and 96 men, mean (range) age was 39.7 years (15-68 years), and mean (range) of follow-up was 32 months (6-148 months). All but 12 patients had a history of previous nasal surgeries. Application of the Cakmak algorithm resulted in 36 patients categorized with type 0 saddle nose deformities; 79, type 1; 50, type 2; 20, type 3a; 7, type 3b; and 14, type 4. Postoperative photographs showed improvement of deformities, and patient surveys revealed aesthetic improvement in 201 patients and improvement in nasal breathing in 195 patients. Three patients developed postoperative infection and 21 patients underwent revision septal surgery. CONCLUSIONS AND RELEVANCE The goal of saddle nose reconstruction should be not only to restore an aesthetic dorsum but also to restore the supportive nasal framework. The surgeon should provide more projected and strengthened septal support before augmentation of saddle nose deformity to improve breathing and achieve a stable long-term result. The Cakmak algorithm is a mechanism that helps surgeons identify the most effective way to maximize septal support and aesthetic appeal. LEVEL OF EVIDENCE 4.

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A Classification for Degree of Crushed Cartilage

Cited by 13 publications

References 5 publications

Percutaneous cartilage injection: A prospective animal study on a rabbit model

Percutaneous cartilage injection: A prospective animal study on a rabbit model

Fluid Cartilage as New Autologous Biomaterial in the Treatment of Minor Nose Defects: Clinical and Microscopic Difference Amongst Diced, Crushed, and Fluid Cartilage

Identifying Septal Support Reconstructions for Saddle Nose Deformity

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