Repair of large nasal septal perforation with titanium membrane: report of 10 cases

Surgical repair of nasal septal perforations: A systematic review and meta-analysis

BACKGROUND

A wide variety of techniques for the surgical repair of nasal septal perforations (NSPs) have been described. Surgical management of NSPs can be broadly divided into open versus endonasal approaches, with additional variables involving unilateral or bilateral flaps, use of grafts, and placement of splints. The objective of this study was to compare surgical approaches and their outcomes.

METHODS

PubMed, EMBASE, and CINAHL Plus databases were examined for patients undergoing NSP repair. English-language studies reporting surgical management of patients with the primary diagnosis of NSP were included. Outcome measures of interest included perforation size, surgical approach characteristics, and success rate defined as complete closure assessed by surgeon postoperatively. The quality of articles was assessed with the methodological index for nonrandomized studies (MINORS) criteria. A random-effects model was used to calculate pooled proportions for the different outcomes.

RESULTS

The electronic database search yielded 1076 abstracts for review. A total of 64 articles met the inclusion criteria, with 1591 patients: 1127 (71%) underwent an endonasal approach and 464 (29%) an open approach. The median (range) MINORS score was 10 (5-12) out of 16 points. Overall, 91% of patients had total closure (95% confidence interval [CI], 0.89-0.93, p < 0.01), with moderate heterogeneity between studies (I²  = 42.03%). There was no difference in closure success between open and endonasal approaches. Use of bilateral versus unilateral flaps, interposition grafts, and intranasal splints and packing were not associated with differences in outcomes.

CONCLUSION

Nasal septal perforation surgical repair success rates are comparable regardless of technique.

Cartilage Sparing Septal Perforation Repair using Rotation Flaps and a Collagen Interposition Graft: A Case Series

OBJECTIVE

Septal Perforations may be asymptomatic or can cause significant problems including nasal obstruction, crusting, bleeding, whistling and in severe cases a change in nasal shape and even pain.

METHOD

The author would like to present a single surgeon case series of septal perforation repairs, managed using an endo-nasal technique, with no external scars. There were 54 consecutive cases between 2011 and 2017. The repair was carried out using mucosal rotation flaps with an interposition graft of porcine collagen matrix. Patients were grouped according to the size of the perforation as measured at the time of the surgery. The patients were then clinically followed up for 1 year, and the recorded outcome measures were: the success of the surgical repair and the patient reported symptoms.

RESULTS

Surgical success was 70% up to 1 cm diameter, 77% from 1 to 2 cm and 82% in perforations from 2 to 3 cm in diameter. No perforation over 3 cm in diameter was successfully closed. Patients were rendered asymptomatic even if the perforation was not closed in between 81% and 91% of patients up to perforations 3 cm in size. Over 3 cm in size 50% of patients reported being asymptomatic.

CONCLUSIONS

This technique is an effective and low morbidity option for patients with small to medium sized septal perforations. For perforations over 3 cm in diameter other options may be more suitable.

Biomaterials in the Reconstruction of Nasal Septum Perforation

INTRODUCTION

Septal perforations are among the most common craniofacial defects. The causes of septal perforations are varied.

OBJECTIVES

The purpose of the study was to develop a septal cartilage implant biomaterial for use in the reconstruction of nasal septal perforations and prepare personalized implants for each patient individually using 3D printing technology.

METHODS

Fragments of septal nasal cartilage from 16 patients undergoing surgery for a deviated nasal septum were analyzed to establish microfeatures in individual samples. A scanning electron microscope was used to estimate the microstructure of the removed septal cartilage. 3D models of porous scaffolds were prepared, and a biomaterial was fabricated in the shape of the collected tissue using a 3D printer.

RESULTS

Of the various materials used in the Fused Deposition Modeling (FDM) technology of 3D printing, PLLA was indicated as the most useful to achieve the expected implant features. The implant was designed using the indicated pre-designed shape of the scaffold, and appropriate topography, geometry and pore size were included in the design.

CONCLUSIONS

The implant's structure allows the use of this device as a framework to carry nanoparticles (antibiotics or bacteriophages). It is possible to create a porous scaffold with an appropriately matched shape and a pre-designed geometry and pore size to close nasal septal perforations even in cases of large septal cartilage defects.

Unilateral Inner Mucoperichondrium Flap From Upper Lateral Cartilage and Inferior Mucosal Advancement Flap Technique for Repair of Septal Perforations

BACKGROUND

Many surgical technique have been described for repair of nasal septal perforations with different success rates. This study aimed to describe authors' surgical technique and discuss its results as well as those reported in the literature.

METHODS

Nineteen patients with nasal septal perforation were operated on between March 2009 and February 2015 at Istanbul University, Istanbul Medical Faculty. The technique described in this article, closure of the perforation with unilateral upper lateral cartilage inner mucoperichondrial flap and inferior meatal advancement flap is an alternative surgical technique.

RESULTS

Nineteen patients with symptomatic nasal septal perforation were operated with this technique. All surgical procedures were performed by the same surgeon. Neither intraoperative nor postoperative major complications were observed in any patients. Preoperative and postoperative symptom scores for nasal obstruction, epistaxis, nasal discharge, crusting, whistling, snoring, and olfactory loss as well as overall discomfort levels were compared using a visual analog scale. Complete closure of the perforation was achieved in 18 patients (95%).

CONCLUSIONS

Small and large perforations may be reliably closed with this technique. Also, this technique can be easily applied via closed or external approach.

Effect of Temporal Fascia and Pedicle Inferior Turbinate Mucosal Flap on Repair of Large Nasal Septal Perforation via Endoscopic Surgery

BACKGROUND

The repair of large nasal septal perforations (NSPs) is one of the most challenging procedures in nasal surgery. The aim of this prospective clinical study was to determine the efficacy of using a pedicle inferior turbinate mucosal flap combined with temporal fascia to repair a large NSP.

METHOD

Between January 2008 and December 2015, 17 consecutive patients with large NSPs underwent septal perforation repair via an endoscopic approach using a pedicle inferior turbinate mucosal flap combined with temporal fascia.

RESULTS

Complete closure of the perforation was achieved in all patients.

CONCLUSION

The pedicle inferior turbinate mucosal flap combined with the temporal fascia technique can easily solve this challenging problem, and the current data from this prospective study suggest that this technique shows promising results.

Primary human nasal epithelial cell response to titanium surface with a nanonetwork structure in nasal implant applications

In nasal reconstruction applications, the response of cells to titanium (Ti) implants is largely determined by the surface characteristics of the implant. This study investigated an electrochemical anodization surface treatment intended to improve the response of primary human nasal epithelial cells (HNEpC) to Ti surfaces in nasal implant applications. We used a simple and fast electrochemical anodization treatment, i.e., applying anodic current, to produce a titanium dioxide (TiO2) nanonetwork layer on the Ti surface with average lateral pore size below 100 nm, depending on the current applied. The TiO2 nanonetwork layer exhibited enhanced hydrophilicity and protein adsorption ability compared with untreated Ti surfaces. In addition, the spreading morphology, cytoskeletal arrangement, and proliferation of HNEpC on the nanonetwork layer indicated excellent cell response characteristics. This research advances our understanding regarding the means by which a TiO2 nanonetwork layer can improve the response of HNEpC to Ti surfaces in nasal implant applications.

Use of porous high-density polyethylene grafts in open rhinoplasty: no infectious complication seen in spreader and dorsal grafts

OBJECTIVE

The aim of this study is to use porous high-density polyethylene grafts (Medpor) in open rhinoplasty and then assess complication rate and aesthetic outcomes.

METHODS

In a prospective cohort study, we performed open rhinoplasty and employed Medpor as rhinoplasty grafts. Then we compared their complication rate.

RESULTS

In a total of 64 patients, 84 Medpor grafts--8 dorsal grafts, 23 strut grafts, 8 rim grafts, 5 button grafts and 10 spreader grafts--were utilized. Moreover, 5septal perforation repairs with Medpor were performed. The complication rates were 5.3% in dorsal graft (complication in dorsal graft was only movement of implant), 21.7% in strut graft and 25.0% in rim graft. No complication was seen in spreader and button grafts. All 5septal perforation repairs were successfully performed with the same rhinoplasty approach.

CONCLUSION

Medpor can be used as dorsal and spreader graft in reconstruction of severe nose deformity with lowest complication rate and without infectious complication and extrusion.

Nasal septal perforation repair: predictive factors and systematic review of the literature

PURPOSE OF REVIEW

Although numerous surgical techniques have been introduced thus far in order to achieve the surgical closure of nasal septal perforation, the repair of nasal septal perforation is still challenging for surgeons and operative techniques are not standardized. Furthermore, predictive factors for successful closure have not been elucidated. This review aimed to investigate predictive factors for complete closure of nasal septal perforation.

RECENT FINDINGS

The size of perforation was the most significant factor for complete closure. Surgical failure occurred more frequently in patients with large perforation (>2 cm) than those with small-to-moderate perforation (≤2 cm). The bilateral coverage over the perforation with vascularized mucosal flap also helped complete closure. Interposition of grafts appeared to assist complete closure, although it was statistically insignificant.

SUMMARY

This review provides information for surgeons on how to predict surgical outcomes of the repair of nasal septal perforation and which surgical techniques to choose in order to obtain better results.

Endonasal repair of septal perforations using a rotational mucosal flap and acellular dermal interposition graft

BACKGROUND

The closure of nasal septal perforations can be challenging based on the etiology, location, and method of closure. We report on a novel method of closure for nasal septal perforations using a unilateral mucosal rotational flap and acellular dermal interposition graft.

METHODS

Twenty patients with nasal septal perforations of various etiologies underwent our method of repair through a closed, endonasal approach.

RESULTS

Out of 20 patients, 17 demonstrated successful closure of their septal perforations, consistent with an 85% success rate. Based upon size, closure rates were 89% for small perforations (<1 cm), 80% for medium perforations (1-2 cm), and complete closure for a single large perforation (>2 cm). Of 20 patients, 19 were completely asymptomatic following surgical intervention, and of the 3 with failed repairs, only 1 patient required revision surgery for persistent symptoms.

CONCLUSION

Nasal septal perforations may cause bothersome symptoms and present a significant reconstructive challenge. Native septal tissue is advantageous due to a rich vascular supply and proximity to the defect, while interposition grafts act as a scaffold for the migration of respiratory mucosa. The method described herein combines these principles to provide a suitable technique for the closure of nasal septal perforations.

Septal perforation repair: mucosal regeneration technique

A novel method for repair of septal perforations. Fifteen volunteers with symptomatic septal perforations were recruited. Open technique rhinoplasty approach was preferred: auricular conchal cartilage graft with intact perichondrium on both sides was harvested and shaped to fit the perforated site and attached to the septum with absorbable sutures. All margins of the graft were covered with nasal mucosa. The severity of patient symptoms was assessed at preoperation, 3 and 6 months postoperatively via visual analogue scale (VAS). Crust formation, whistling, nasal blockage, epistaxis and overall comfort were evaluated. Mucosal physiology was assessed by nasal mucociliary clearance time. The mean age of the patients was 47.3 years. Average perforation size was 1.86 ± 0.78 cm. 14/15 (93.3%) perforations were repaired, and only one patient required revision surgery. VAS scores improved significantly (p < 0.001). Mean mucociliary clearance time improved from 17.6 ± 3.83 to 10.3 ± 3.30 min and 9.3 ± 3.36 min at 3 and 6 months, respectively. This is a novel, simple and safe method for repairing the deficient mucosal area in septal perforations up to 25 mm in diameter.