| Cartilage Grafts in Nasal Surgery
Alvin I. Glasgold, M.D.,* Mark J. Glasgold, M.D.,* and Frederick H. Silver, Ph.D.**
ABSTRACT Cartilage grafts are being used with increasing frequency in nasal surgery. particularly with the growing popularity of open rhinoplasty. The properties of cartilage that make it a preferred grafting material are discussed as well as the historical data relating to the survival of cartilage autografts and homografts. The preferred source of cartilage grafts has been the patient's septum. This is not always feasible because of prior surgical removal or inadequate strength or size. The purpose of this paper is to describe the types of cartilage grafts commonly available for use in nasal surgery. The advantages and limitations of each are discussed. Four clinical cases are presented, demonstrating the use of septal cartilage autograft, septa/ homograft, irradiated rib cartilage homograft, and conchal cartilage autograft.
Cartilage has certain unique properties that make it a widely used graft material. It is considered to be immunologically privileged; that is, it has a low degree of antigenicity. This may be a result of a combination of its avascularity and the presence of an inert matrix surrounding the chondrocytes. Structurally, cartilage is composed of type 1I collagen and proteoglycans that combine to provide it with its tensile strength and toughness.
The clinically successful, long-term use of autogenous cartilage grafts was popularized by Peer in the 1940s, including particularly the use of septal cartilage, which he considered the ideal graft. Gibson and Davis studied cartilage extensively, both live autografts and homografts stored in Merthiolate. They reported that a cartilage homograft would eventually undergo complete resorption. However, after reviewing some successful long-term clinical results, they felt that encapsulation of the homograft could result in long-term graft survival. Davis and Gibson also suggested that multiple cuts into the surface of a graft or implanting it in a bloody field would significantly increase resorption. Gibson" showed the long-term viability of autografts based on incorporation of radiolabeled sulfate.
Many authors, including Muhlbauer et al., Schofield, and Rasi, have described successful long-term results with Merthiolate-stored cartilage homografts. Hagerty et al. demonstrated that cartilage stored in Merthiolate for a few days killed the chondrocytes. Dingman and Crabb used irradiated rib cartilage homografts in facial surgery and reported on the successful survival in patients observed for up to 3 years. Schuller et al." confirmed their findings, following patients for a similar length of time. A more recent follow-up to Schuller's patients questions the results over a 10-year period. Donald's 1980 survey of American Academy of Facial Plastic and Reconstructive Surgery members confirmed the long-term survival and satisfaction with nonviable homografts. In another study using animal experiments, Donald and Col showed a high rate of resorption (85.7%) of irradiated cartilage homografts and a lower rate of resorption of Merthiolate-stored homografts (43.8%) over a 2-6-year period.
The purpose of this paper is to describe the types of grafts available for use in nasal surgery and present four clinical cases demonstrating the use of septal cartilage autograft, septal homograft, irradiated rib cartilage homograft, and conchal cartilage autograft material.
next page>> |
