[Experience with individual obturators to treat nasal septum perforation]

[Prosthetic treatment of nasal septal perforations : Results with custom-made silicone buttons]

BACKGROUND

Perforations of the nasal septum can be very disturbing for patients due to increased crust formation, nose bleeds, obstruction of nasal breathing and whistling sounds during nasal breathing. The aim of this study was to evaluate how the symptom burden can be alleviated by custom-made silicone buttons derived from an impression mold.

MATERIAL AND METHODS

A retrospective study was carried out to evaluate 45 patients with symptomatic septal perforations, who have been treated over a period of 8 years. The magnitude and localization of the perforations were measured on the impression molds as well as in situ in 28 patients. The symptoms were rated on a visual analogue scale (VAS) before and after treatment (response 64%).

RESULTS

No correlation was found between the size of the perforation and the distance from the nasal opening. Of the patients 31 (69%) still had the septal button in situ at the time of the last follow-up. The magnitude and localization of the perforation were not found to be predictors of treatment success. The following symptoms showed a highly significant improvement: crust formation (VAS median 75 vs. 31), nose bleeds (VAS median 50 vs. 0), obstruction of nasal breathing (VAS median 84 vs. 14) and whistling breathing sounds (VAS median 69 vs. 0). Unpleasant odor and symptoms of sinusitis did not show significant changes. The long-term septal button carriers rated the improvement with a median of 91% on the VAS.

CONCLUSION

The success of prosthetic closing of septal perforations by a custom-made button still cannot be accurately predicted. The majority of patients were extraordinarily satisfied because the symptom burden could be significantly reduced.

Prosthetics for Nasoseptal Perforations

Objective

Prosthetics serve as an option for nasoseptal perforation treatment in patients who have active systemic disease, are poor surgical candidates, or wish to avoid surgery. Through systematic review of the literature on prosthetics for nasoseptal perforation treatment, the objective of the present study is to critically appraise previous studies, evaluate the success rate for nasoseptal prosthetics, provide evidence-based guidelines for nasoseptal prosthetic use, and identify areas for further investigation.

Data Sources

Cochrane Controlled Trials Register, EMBASE, PubMed, and Web of Science.

Review Methods

Data sources were queried for relevant articles published from 1965 to 2013. Articles were selected for inclusion if they presented primary data for human nasoseptal perforation treatment utilizing prosthetic materials. Each included article’s level of evidence and risk of bias were identified and grades of recommendation were assigned. A quantitative meta-analysis was performed on articles with low risk of bias.

Results

The search yielded 4756 abstracts for review, with 23 included case series and 5 case reports; 706 total cases of prosthetic nasoseptal perforation treatment were identified. All articles provided level 4 evidence, with an overall conclusion grade of C for improvement in nasoseptal perforation symptoms, prosthetic in situ rate, and complication rate. Meta-analysis of 6 low-risk-of-bias studies with 297 patients demonstrated an overall success rate of 65%.

Conclusions

The literature provides level 4 evidence for the efficacy and safety of prosthetics for nasoseptal perforation treatment with favorable success rates and few reports of complications—only 1 fungal infection and 9 unspecified infections—in 706 cases.