Rib cartilage provides a plentiful source of graft material for any rhinoplasty need. While its benefit is the volume it provides, its disadvantage is in its shape. Rib cartilage has variable thicknesses, is round in shape and is rarely straight. Carving it into the form needed for dorsal augmentation is always required and with that maneuver comes the risk of postoperative graft warping.
To circumvent the possibility of warping in rib cartilage grafting the concept of dicing the graft has been used for some time. Rather than a solid piece of carved rib cartilage, the graft is particulated with a blade into small pieces or cubes. This dicing maneuver creates a pile of cartilage pieces that then requires a containment method to shape and place it.
Before creating the graft shape I prefer to use a cartilage moralization method to make the small pieces even softer/more malleable. This takes the stiffness out of the cubes and makes them even easier to contain by wrapping them together whether it is within a fascia, allogeneic dermis or a collagen mesh/sheet.
Once wrapped into the containment material one has a very movable graft that has zero chance of warping or becoming deformed as it heals. This crushed diced cartilage graft (CDCG) is uniquely applied to rib grafts because of their greater cartilage stiffness. Once placed into the dorsum of the nose the skin is rewrapped over it and it is then molded externally into the desired shape. A metal splint applied at the end of surgery helps maintain this shape.
When the splint is removed a week later the CDCG already has a firm shape. Fibrovascular ingrowth occurs very quickly in this type of rib graft due to its porosity between the diced cartilage pieces.
Dr. Barry Eppley
Indianapolis, Indiana