DOI No.: 10.21176/ ojolhns.0974-5262.2016.10.

BEHAVIORAL STUDY OF CONCHAL CARTILAGE AUTOGRAFT

AN ANIMAL MODEL RESEARCH
*Belaldavar B. P, **Modhol R. S, ***Dhorigol Vijayalaxmi, ****Belaldavar Chetan, *****Patil Anand, ******Nadagouda Sudha
Date of receipt of article -23-2-2016
Date of acceptance -2-5-2016
DOI-10.21176/ojolhns.2016.10.1.11
ABSTRACT
Objective: To investigate the behavioral pattern of conchal cartilage as an autograft material in respect to gross
changes and microscopic changes in rabbit.
Method: Conchal cartilage grafts were taken from the auricle of 8 white New Zealand rabbits with intact
perichondrial layers. They were categorized as non-implant and explant with two types that is mildly crushed
(CR) and uncrushed cartilage (UCR). These grafts were buried into the subcutaneous pockets in the upper
paraspinal area of the same animal. The microscopic behavioral pattern of explanted buried graft after four
months was evaluated.
Results: Definitive behavioral changes were noticed in both the categories with respect to various gross and
microscopic parameters in relation to chondrocyte mass
Conclusion: The graft will be smooth surfaced and pliant because of the perichondrium on either side and for
mild crushing. Thus the Rhinoplasty surgeon will have temporal idea about the graft.
Key words: Conchal cartilage grafts, White rabbit, Histopathology, Rhinoplasty.

Every cosmetic surgeon of nose often comes across

patients having nasal deformities especially obvious or
subtle dorsal deformities and they do seek surgical
solution for the same. But for correction and
augmentation of same grafts may be needed and
necessary. Various materials are widely used for nasal
augmentation 1,2. Cartilage grafts are widely being used
compared to the other grafts, in rhinoplasty to correct
obvious or subtle irregularities on the nasal dorsum
and to achieve an acceptable smooth surface. Even if
there is a palpable step or depression at the osteotomy
site, onlay grafting using cartilage or ethmoid bone can
be done in that area 3.
Ideally, autogenous tissue are used because they
carry the least risk and complications but the amount
of tissue required for augmentation leaves little choice
other than rib cartilage graft 4.
When a autogenous tissue is used for subcutaneous
augmentation, it is best to use crushed or uncrushed
cartilage or uncrushed bone since they remain viable 5.
Evaluation of autogenous and allogenous grafts
implanted in the nose is quite challenging for several

reasons, including the possibility of unpredictable

complications leading to catastrophic disfigurements,
the impossibility of obtaining pathological specimens
and the need for a long follow up period for stable
results 6. In the present study, we have made an effort
to compare the fate, gross and microscopically, of the
crushed and uncrushed autologous auricular cartilage
with intact perichondrium after 4 months of
implantation.
MATERIALS AND METHODS
After obtaining institutional Ethics in Animal
Experiments approval this research study was carried
out at central experimental animal house of our
institution and in compliance with the guidelines of
CPCSEA. A total of 8 healthy adult male white New
Affiliations:
*,**Professor, Department of ENT & HNS,***Professor Dept of
Pathology., J N Medical College, KLE University, Belagavi,****Lecturer
Dept of Oral Pathology, K L E Institute of Dental Science, KLE University,
Belagavi, *****,****** Senior Veterinary Consultant. Govt of Karnataka.
Address of Correspondence:
Prof.Belaldavar B. P,.Professor, Department of ENT &HNS. J N Medical
College, KLE University, Belagavi, Karnataka.
Mob.: 919845274729
Emai: puttwwa@rediffmai.com

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Vol.-10, Issue-I, Jan-June - 2016

INTRODUCTION

DOI No.: 10.21176/ ojolhns.0974-5262.2016.10.1

Zealand rabbits, were acquired for the study from the

registered animal breeder. As per the guidelines of
ICMR they were taken care of. All animals were
separately nurtured in a controlled environment.
PROCEDURE
After animals were anaesthetized with gluteal
intramuscular injection with Ketamine hydrochloride
and Xylazine Hydrorochloride, a 1040 mm sized
cartilage graft with intact perichondrium on both sides
was harvested from right auricle and this was further
sectioned into four blocks of each 1010 mm size. Two
blocks of these were mildly crushed with cartilage
crusher and two were left without crushing.
Immediately one crushed and another uncrushed
cartilage blocks were sent for histopathological analysis
as non-implant grafts. Subcutaneous pocket was created
at the upper paraspinal region and one crushed and
another uncrushed cartilage grafts were implanted into
these pockets separately. The pockets were sutured and
the implanted grafts were left at the recipient sites for
4 months. Adhering to the similar implantation
operative protocol both the implanted grafts were
explanted after four months without sacrificing the
animals. The explanted samples was examined
histopathologically in H & E section for cartilage graft
viability

Vol.-10, Issue-I, Jan-June - 2016

RESULTS
On gross examination after four months the
explants appeared softer and pliable with soft tissue
covering all around with intact perichondrial coverings
with more vascularity around the implanted bed but
almost same thickness as that of nonimplant graft.On
microscopic examination, non-implant uncrushed
cartilage revealed intact perichondrial coverings and in
explant grafts though the perichondrial covering was
intact, the chondrocyte proliferation was mild. In
crushed cartilage few sparse islands of bare areas without
the perichondrium in both non-implant and explant
specimens were noted indicating abraded areas because
of crushing but there were no damaged or fragmented
areas. Table-1: P value for pre implant and explant
comparison of types CR and UCR cartilage using
Wilcoxon signed ranks test.
Comparing the crushed or uncrushed cartilages
to their counter parts in non-implant and explants, the
p value was not significant when Fishers exact test was
applied.
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DISCUSSSION
Rhinoplasty has become one of the most
frequently requested and performed surgical procedures
for both functional and aesthetic purposes. As an
attention attracting prominence, even the slightest
disfigurement of the nose causes serious disturbance to
the patient before or after operation. Functional
problem also cause discomfort [6]. To surpass all these
disadvantages numerous allogenic materials have been
developed. Silicone implants are therefore the most
prevalent, as they are durable, easily placed and removed
and facilitate sculpturing 7. However, alloplast implants
may result in rejection, migration, extrusion and
infection6. As it was progressed to have different
materials for augmentation as well to have cushioning
many other permutation and combination with good
outcome are proposed that is diced cartilages in surgicel
with or without fascia or patient blood mixing and so
and so forth 8. The fine textured cartilage mass is
wrapped in Surgicel to obtain a mould form. But
overcorrection is desirable because of partial
resorption9, 10. Resorption, donor site limitation and
morbidity are the major disadvantages of autografts 1.
On the contrary in our study design there is no need
of other donor site for soft tissue harvest for cushioning
and smoothness as the autograft is harvested with intact
perichondrium on both sides and mild crushing of the
conchal cartilage does not cause any loss of its viable
integrity and distortion but on the other hand renders
the graft acceptably softer and pliable with smooth
surface. This can be adapted in human beings, as the
autologous conchal cartilage graft of an individual can
be a near ideal and optimum graft for finer dorsal
configuration refining in corrective cosmetic
Rhinoplasty. This type of study appears to be

DOI No.: 10.21176/ ojolhns.0974-5262.2016.10.1

3.

Yong JJ, Jong HW, Vikas S, Bong JL:

Percutaneous root osteotomy for correction of
the deviated nose. Am J Rhinol 2007; 21, 515519

4.

Feng CT, Chuh KL: Analysis of nasal periosteum

and nasofrontal suture with clinical implications
for dorsal nasal augmentation Plast and reconst
Surg, 2010; 126 (3);1037-1047.

5.

Breadon GE, Keren EB, Neel HB: Autograft of

uncrushed and crushed bone and cartilage.
Experimental observations and clinical
implicatipons. Arch otolaryng 1994, 105 (20):7580.

6.

Harun C, Afsin U, Ugar K et al, Rhinoplasty

model in rabbits. Plast and Reconstructive Surg
2006;117 :1851-1859.

7.

Byrd HS, and Hobar PC: Alloplastic nasal and

perialar augmentation.Clin.Plast.Surg.1996 ;
23:315.

8.

Erol OO. The Turkish delight; a pliable graft for

Rhinoplasty. Plast Reconstr Surg 2000; 105: 22292243.

9.

Daniel RK, Calvert JW, Diced cartilage grafts in

rhinoplasrty surgery. Plast Reconstr Surg 2004;
113: 2156-2171

CONCLUSION
We would like to confess that as it is not possible
ethically and clinically to harvest the specimens in
human beings for this type of study our results with
this experimental research model in rabbits is reasonably
an alternative way of knowing the behavioral pattern
of autologous conchal graft as it is near to studies in
human beings. Authors intend to continue the research
further to evaluate long-term effects in cosmetic surgery
of nose.
DISCLOSURES
(a) Competing interests/Interests of Conflict- None
(b) Sponsorships - None
(c) Funding - None
(d) No financial disclosures
REFERENCES
1.

2.

Torsum Z, Karbekmez FE, Keskin M, Duymaz

A, Saraci N. Allogenous cartilage graft versus
autogenous cartilage grafts in augmentation
Rhinoplasty. A decade of clinical experience.
Aesthetic Plast.Surg 2008;32:252-260.
Harn J, Miller PJ. Expanded polytetraflouroethylene implants in Rhinoplasty. Literature
review, operative technique and outcome. Facial
Plastic surgery. 2003;19:331-339.

10. Yilmaz S, Ercocen ER, Can Z et al. Viability of

diced, crushed cartilage grafts and the effects of
Surgicel on a cartilage grafts. Plast Reconstr Surg
2001; 108: 1054-1060.

Vol.-10, Issue-I, Jan-June - 2016

conducted first time in India as our literature search

did not yield any other mention of it. But nevertheless
this type of research needs to be experimented for still
longer time of duration.

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