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

Abstract

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.

Keywords: crushing cartilage; diced cartilage; fluid cartilage; minor nose defects; rhinoplasty.

Figure 1

Autologous fluid shaving cartilage preparation compared with other products. (A) Cartilage preparation using as source nasal septum (with or without perichondrium). (B) Soft tissue attachments were debrided from the cartilage block using Adson Brown forceps in the non-dominant hand of the surgeon and surgical blade (number 15) in the perpendicular plane to scratch the edges of the cartilage block with very gentle pressure shaving very thin and small pieces. (C) Diced cartilage. (D) Crushing cartilage.

Figure 2

All cartilage products obtained. (A,B) Fluid, diced, and crushing cartilage products obtained by septal cartilage in comparison. (C) The insertion of cartilage paste obtained in a 1-mL Luer lock syringe.

Figure 3

Histological and morphological analysis of cartilage tissue and cultured human chondrocytes (HCs) from different procedures. (A–D) Haematoxylin–eosin-stained paraffin-embedded sections of cartilage samples from the different procedures (left and center) and the corresponding cultured HCs (right); from top to bottom: whole cartilage, fluid, diced, and crushing samples. Arrow head, mitosis.

Figure 4

Phenotypic characterisation of cultured HCs. (A) Representative image of Alcian–PAS staining of cytospinned HCs (in particular, fluid sample). (B) Representative RT-PCR showing chondrogenic marker COL2A1 and ACAN mRNA expression (in particular, fluid sample). Abbreviations: MW, molecular weight; PCR-, negative control.

Figure 5

43-year-old female patient affected by nasal obstruction and minor soft tissue defects in frontal view. (A) External nose analysis showed external nasal valve collapse, deficit of supra tip projection, deficit of radix and dorsum volume. Anterior rhinoscopy showed a deviated nasal septum and bilateral stenosis of the internal valves. (B) The fluid cartilage as filler was injected on the external nasal valve collapse, in the alar cartilage side, or in the radix, or in the nasal dorsum or in the supra tip area. Post-operative follow-up evaluation, 12 months after the fluid cartilage injection showed optimal aesthetic results and an improvement of nasal obstruction.

Figure 6

43-year-old female patient affected by nasal obstruction and minor soft tissue defects in detail projection. (A) External nose analysis showed better-left nose deviation, external nasal valve collapse, deficit of supra tip projection, deficit of radix and dorsum volume. Anterior rhinoscopy showed a deviated nasal septum and the bilateral stenosis of the internal valves. (B) The fluid cartilage as filler was injected on the external nasal valve collapse, in the alar cartilage side, in the radix, in the nasal dorsum, or in the supra tip area. Post-operative follow-up evaluation, 12 months after the fluid cartilage injection, showed optimal aesthetic results and an improvement of nasal obstruction.

Figure 7

Computerised tomographic (CT) scans of patient showed in Figure 4. (A,C,E) Pre-operative situation. (A) CT scans, T1 medium signal intensity, showed the pre-operative situation with soft tissue defect of the nasal tip and nasal septum deviation. (B) CT scans, T1 medium signal intensity, showed the post-operative situation with an improvement of soft tissue volume in the treated area. (C) CT scans, T2 high signal intensity, showed the pre-operative situation in detail, with cartilage defect and nasal valve collapse. (D) CT scans, T2 high signal intensity, showed the post-operative situation with correction of the nasal valve collapse. (E) CT scans, T2 high signal intensity, showed the detail of the pre-operative situation with soft tissue defect of the nasal tip and cartilage defect in detail. (F) CT scans, T2 high signal intensity, of the same area after 12 months show the regenerated site in the post-operative image with soft tissue volume improvement and the correction of the nasal septum deviation.