Dec 17

To Crush or Not To Crush: What is the fate of crushed cartilage used in rhinoplasty?

Hamlet, crushed cartilage
To crush, or not to crush, — that is the question: —
Whether ’tis better in the mind to only think about crushing
The cartilage, but leaving it intact for grafting,
Or to take arms against the cartilage,
And by crushing it? — To sleep, knowing the cartilage will not show through, —

The heart-ache, and the thousand natural shocks
That cartilage is heir to, — ’tis a consummation…

To sleep, perchance to dream: — ay, there’s the rub;
For in that sleep of crushed cartilage what dreams may come,
The perfect nose…
For those of us who do a lot of rhinoplasty and revision rhinoplasty, there is often the moment some time during the case when we question whether we should crush cartilage hoping that it will last and lie more discreetly? Or whether we should leave it intact fearing that if we crush it, over time it will reabsorb?
Recently there was an interesting article that looked at the survival of crushed cartilage vs non crushed cartilage in the Archives of Facial Plastic Surgery. Not surprisingly, they found that crushed cartilage did not appear to survive as well in their animal model.
Unfortunately for those of us who operate on people, the study looking into crushed cartilage from rabbits really does not help answer any questions. For one thing, while they tried to standardize how hard they crushed, in real life this is very difficult to translate into our own practice.  Moreover, they placed all the noncrushed cartilage on the dorsum and all crushed cartilage on the nasal sidewall- perhaps they could have switched it up to see if placement made a difference.
So what does this mean to anyone doing or having rhinoplasty: simply said, it appears that crushed cartilage is a great way to conceal irregularities, fill defects and create smoother surfaces, but it is important to be experienced so that the cartilage is not so crushed that it disappears over time….there is the rub.
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