The Silicone Turkish Delight for Dorsal Augmentation in Rhinoplasty

Abstract

Rhinoplasties are the most challenging facial aesthetic procedures with the majority of the cases requiring dorsal augmentation either in the form of autogenous or alloplastic materials. Although autogenous grafts are the gold standard, these grafts have their innate issues such as donor site morbidity, occasional displacement, resorption, tendency to warp or develop sharp edges over time with increased perceptibility and clinical visibility of the graft with time. These issues were addressed by Erol in 2000 who advocated the use of finely diced autologous cartilage wrapped in a monolayer of surgical and termed it Turkish delight. This technique has been extensively modified by surgeons across the world with an attempt to forgo the use of autogenous grafts preventing donor site morbidity and replacing it with alloplastic materials. Silicon's inert nature, resorption resistance, absence of a secondary surgical site and economical value make it a widely utilized allograft augmentation option in Asian countries. The authors hereby present a modification of the original Turkish delight technique by utilizing diced silicone pieces amalgamated with 1 to 2 ml of autologous blood and wrapped in monolayer of surgicel (oxidized cellulose). The technique produced clinically stable results in 27 patients who were followed up for a period of 24 to 60 months (average 30 months). Improved pliability, negated risk of graft extrusion with no donor site morbidity are the key advantages of this technique over conventional autologous grafts and silicon block augmentation techniques. These results point towards the viability of the technique for performing dorsal augmentation in rhinoplasty.

Promotion of diced cartilage survival and regeneration with grafting of small intestinal submucosa loaded with urine‐derived stem cells

“…During the operation, there are several choices for wrapping materials, which include perichondrium, 14 temporalis muscle fascia 50 and rectus muscle fascia 8 . Although many clinical trials have compared the effect of various materials in longer terms, there is still no gold standard among such materials 51,52 . These wrapping materials as autogenous tissues possess favourable biocompatibility, but with certain limitations regarding the application and effect, including the available quantity, aggravation of injury, prolonging of operating time and complications at the donor site.…”

“… 8 Although many clinical trials have compared the effect of various materials in longer terms, there is still no gold standard among such materials. 51 , 52 These wrapping materials as autogenous tissues possess favourable biocompatibility, but with certain limitations regarding the application and effect, including the available quantity, aggravation of injury, prolonging of operating time and complications at the donor site. Therefore, we have proposed to use the SIS or U‐SIS membranes as wrapping materials for diced cartilage graft, and proved that both could promote chondrogenesis and suppress dedifferentiation of chondrocyte in vitro, increase the survival of diced cartilage in short terms, and improve its regeneration in longer terms in rabbit models.…”

Autologous Costal Cartilage With Expanded Polytetrafluorethylene (ePTFE) Implants for the Treatment of Nasal Deformity After Unilateral Cleft Lip Repair

“…Even if the cartilage of the back of the hand cannot be completely deformed by reverse suturing, it can be used to avoid the deformation of the rib and medulla. 4 Therefore, we used the ePTFE materials together with costal cartilage to avoid the problem. The ePTFE material will not deform in the back of the nose, with fast operation speed and good effect.…”

“…But using autologous costal cartilage for the surgery also has drawbacks such as the deformation of the cartilage. Even if the cartilage of the back of the hand cannot be completely deformed by reverse suturing, it can be used to avoid the deformation of the rib and medulla 4. Therefore, we used the ePTFE materials together with costal cartilage to avoid the problem.…”