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Published on: June 20, 2018
Ultrasound visualization of augmentation rhinoplasty using diced cartilage framework: A pictorial study
Barbara Kofler1, Theresia Steinkellner2, Michelle Liu3
1Department of Otorhinolaryngology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; Department of Otorhinolaryngology and Maxillofacial Surgery, Hospital Franz Tappeiner, Meran/Merano, South Tyrol, Italy.
Background:
Diced cartilage (DC) plays an integral role in rhinoplasty, and its application is well established in nasal dorsal augmentation rhinoplasty as a diced cartilage framework (DCF).
Methods:
Fifteen patients requiring nasal dorsal augmentation were included. Two different types of DCF were applied: DC wrapped in fascia lata or Lyomesh® and DC embedded in platelet-rich fibrin (PRF). Postoperative ultrasound follow-ups were performed at intervals of one month, three months, and one year after surgery using a high-frequency linear ultrasound transducer. The aim was to depict the viability of the DCF in vivo.
Results:
DCF was successfully depicted using ultrasound imaging in all 15 patients. Ultrasound rendered DC as hypoechoic and inhomogeneous areas. Perifocal hypoechoic edema was detected, which significantly decreased by the one-year follow-up. During the one-year postoperative period, very little DC had decreased in diameter and the framework was fully intact, with no signs of migration. On high-frequency ultrasound, DC wrapped in fascia lata or Lyomesh® appeared as a hypoechoic and inhomogeneous area clearly limited by a thin hyperechoic envelope material, whereas DC embedded in PRF presented as a hypoechogenic area that spread laterally along the bone and nasal cartilage on both sides. Using color Doppler imaging, neovascularization of the DCF was identified in 7 of 15 patients at the postoperative examination.
Conclusion:
High-resolution ultrasound is an accurate, non-invasive imaging method appropriate for visualizing DCF in augmentation rhinoplasty. Additionally, it is possible to detect nascent neovascularization within grafts by using color Doppler imaging.
