What is the optimal surgical manipulation for cartilage autografts in rhinoplasty?
In this in vitro investigation of 4 distinct surgical manipulations compared with a control group using cartilage from bovine snouts, the crushing manipulation was statistically significantly worse than all other manipulations with shaving, dicing, and scoring following, respectively, by various quantitative assays.
When clinical needs dictate the use of cartilage grafts, surgeons should consider the least damaging, yet adequate cartilage manipulation to enhance clinical outcomes.
This study characterizes and compares common surgical manipulations’ effects on septal cartilage to understand their implications for rhinoplasty outcomes based on cell viability and cartilage health.
To illustrate distinct differences in the impact of various surgical manipulations on septal cartilage in an in vitro septal cartilage model. A secondary objective is to better understand the chondrocyte’s response to injury as well as how alterations in the extracellular matrix correspond to chondrocyte viability.
Design, Setting, and Participants
In this bench-top in vitro porcine model using juvenile bovine septal cartilage from bovine snouts, easily obtainable septal cartilage was used to generate large numbers of homogenous cartilage specimens. Quantitative outcomes at early and late time points were cell viability, cell stress, matrix loss, and qualitative assessment through histologic examination. The study was performed at a single academic tertiary care research hospital.
Four common surgical manipulations were contrasted with a control group: crushed cartilage, scored cartilage, diced cartilage, and shaved cartilage.
Main Outcomes and Measures
Following the manipulation of the cartilage, the quantitative outcomes were glycosaminoglycan release to the media, lactate dehydrogenase release to the media, and cell death analysis through apoptosis staining. The qualitative outcomes were histologic staining of the manipulated cartilage with safranin-O/fast green stain to identify proteoglycan loss.
The crushing followed by shaving manipulations were the most damaging as indicated by increased levels of lactate dehydrogenase release, glycosaminoglycans loss, and cell death. Matrix loss did not increase until after 48 hours postinjury. Furthermore, chondrocyte death was seen early after injury and accelerated to the late time point, day 9, in all manipulations. Conversely, cell stress was found to be greater at 48 hours postinjury, which then declined to the late time point, day 9.
Conclusions and Relevance
The crushing manipulation followed by shaving and then dicing were the most destructive methods of cartilage manipulation relative to control specimens. Collectively, these outcomes demonstrate the range of injury which occurs with all septal cartilage manipulations and can inform rhinoplasty practice to use the least damaging effective surgical manipulation to obtain the desired outcome.
Level of Evidence
Thomas WW, Brody RM, Alotaibi AD, et al. Characterization of Injury Induced by Routine Surgical Manipulations of Nasal Septal Cartilage. JAMA Facial Plast Surg. Published online May 30, 2019. doi:10.1001/jamafacial.2019.0169
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