Immediate Reconstruction After Removal of Nasal Prosthesis Using Diced Cartilage Wrapped With Temporal Fascia

Abstract

Various materials are used for nasal augmentations. Silicone is the most prevalent because it is durable and facilitates sculpturing. However, the unfortunate patient who presents with complication of the nasal implants and wants to remove them is vexed with a significant resultant cosmetic defect if the implant is removed. However, the patients who have some troubles after augmentation by the implants tend to hate the use of the prosthesis again. Ideally, immediate reconstruction would be offered to the patient, sparing him/her the deformity left by removal of the implant. We treated 16 patients who had undergone immediate nasal reconstruction after removal of foreign body. We reconstructed nasal deformity by diced cartilage wrapped with temporal fascia. The cartilage harvested from the ear concha was finally diced into 1- to 2-mm cubes. A bag was made from deep or superficial temporal fascia, and diced cartilage cubes were placed in the bag, which was grafted onto the nasal dorsum. This procedure had several advantages including getting natural contouring and enough volume and absence of foreign body reaction. It was also soft to the touch compared with prosthesis. The fascia could support the thin dorsum skin. The nasal augmentation effect of this procedure was comparable with that of prosthesis methods. It had lower risks for infection and exposure and provided more psychologic comfort. The nasal deformities were successfully reconstructed using diced cartilage wrapped with temporal fascia. We believe that this is the good method for the immediate nasal reconstruction after the removal of foreign body.

Diced Cartilage in Fibrin Glue for Dorsal Reconstruction as Part of Staged Paramedian Forehead Flap Reconstruction

“…Technique modifications to address these issues include: wrapping or covering in fascia, wrapping in oxidized methylcellulose, and solidifying with fibrin glue. [4][5][6][7][8][9]12,14 The increased utilization of diced cartilage is partially attributed to Erol et al who reported on 2365 patients over 10 years. All patients underwent rhinoplasty using diced cartilage wrapped in oxidized methylcellulose with successful outcomes and graft stability.…”

“…6 Compared to diced cartilage alone, fascial containers reduce aberrant dispersion of cartilage and allows molding. 1,5 Diced cartilage with fibrin glue has been described as an alternative or adjunct to fascia. The application of the fibrin glue to diced cartilage scaffolding improves formability and insertion without compromising long-term stability.…”

“…Potential disadvantages include risk of overcorrection, visibility, and junctional step-offs. Technique modifications to address these issues include: wrapping or covering in fascia, wrapping in oxidized methylcellulose, and solidifying with fibrin glue 4–9,12,14 …”

“…All patients underwent rhinoplasty using diced cartilage wrapped in oxidized methylcellulose with successful outcomes and graft stability 6 . Compared to diced cartilage alone, fascial containers reduce aberrant dispersion of cartilage and allows molding 1,5 . Diced cartilage with fibrin glue has been described as an alternative or adjunct to fascia.…”

“…Given its success in rhinoplasty, it is a natural extension to use this technique in complex nasal reconstructions. Takeda et al 5 described nasal reconstruction using diced cartilage wrapped in temporal fascia in 16 patients, following removal of silicon prostheses reporting successful reconstruction and patient satisfaction. Gordon et al 9 presented a novel technique wrapping diced cartilage in an easily moldable acellular dermal matrix with good results at 1 year for both cosmetic and reconstructive nasal surgery.…”