Nasal Septal Perforation Closure by “Sandwich Grafts”: Technique, Initial Results

2021 ◽  
Author(s):  
Mattis Bertlich ◽  
Friedrich Ihler ◽  
Maya Bertlich ◽  
Mark Jakob ◽  
Martin Canis ◽  
...  
Keyword(s):  
Nasal Septum ◽  
Case Series ◽  
Septal Perforation ◽  
Auricular Cartilage ◽  
Reliable Technique ◽  
Temporal Fascia ◽  
Nasal Septal Perforation ◽  
Foreign Materials ◽  
Septal Perforations ◽  
Initial Results

AbstractNasal septal perforation closure represents a considerable surgical challenge. Many techniques rely on the implantation of foreign materials that pose a persisting threat of infection. The authors have identified a reliable technique closing septal perforations by an autologous “sandwich graft.” It is layered around a piece of auricular cartilage, covered with temporal fascia, thus emulating the physiological layers of the nasal septum. Finally, the prepared graft is then sewn into the perforation in an underlay technique and kept in place by septal splints for 4 weeks. The technique is easily feasible and strives to reconstruct the nasal as physiological as possible. The data obtained from a case series of 11 patients highlights the efficacy of the technique.

Modified tragal cartilage – temporoparietal and deep temporal fascia sandwich graft technique for repair of nasal septal perforations

1997 ◽  
Vol 111 (5) ◽  
pp. 435-437 ◽  
Author(s):  
A. Hussain ◽  
P. Murthy
Keyword(s):  
Operative Technique ◽  
Observation Time ◽  
Septal Perforation ◽  
Sandwich Technique ◽  
Temporal Fascia ◽  
Nasal Septal Perforation ◽  
Septal Perforations

AbstractFifteen cases of nasal septal perforation were repaired with a tragal cartilage–temporoparietal and deep temporal fascia sandwich technique using a modification of the approach previously described (Hussain and Kay, 1992). Successful closure was achieved in 14 patients (100 per cent) after an observation time of up to two years. The operative technique and advantages of the modified approach are described.

Septal Perforation Repair Utilizing an Anterior Ethmoidal Artery Flap and Collagen Matrix

2018 ◽  
Vol 33 (3) ◽  
pp. 256-262 ◽  
Author(s):  
Marina N. Cavada ◽  
Carolyn A. Orgain ◽  
Raquel Alvarado ◽  
Raymond Sacks ◽  
Richard J. Harvey
Keyword(s):  
Corticosteroid Injection ◽  
Case Series ◽  
Collagen Matrix ◽  
Contralateral Side ◽  
Septal Perforation ◽  
Closure Rate ◽  
Reliable Technique ◽  
Nasal Septal Perforation ◽  
Ethmoidal Artery ◽  
Anterior Ethmoidal Artery

Background Nasal septal perforation repair remains a challenge with no standard technique for repair recognized. Objective To describe the combination of an anterior ethmoidal artery flap with a collagen matrix inlay as a successful technique for nasal septal perforation repair. Methods A case series of consecutive patients who underwent nasal septal perforation repair with an anterior ethmoidal artery flap with an inlay collagen graft was conducted. Demographic data, preoperative features of the perforation (size, location, and presence of chondritis), and postoperative outcomes were analyzed; closure rate, mucosalization rate (of the contralateral side at 21 and 90 days), and complications (crusting, bleeding, obstruction, infection, and rehospitalization <30 days) were documented. Results Thirteen patients (age: 49 ± 15 years, 30.8% women) were assessed. The perforation size was 1.6 ± 0.9 cm (range: 0.3–3.5 cm) and located 1.2 ± 0.5 cm (range: 0.5–2.0 cm) posterior to the columella. Chondritis was present in 69.2%. The closure rate was 100% (95% confidence interval [CI]: 77%–100%) at both 21 and 90 days. One patient required a free mucosa graft to an area of persistent crusting on the contralateral side (7.7%). Complications were low; bleeding 0%, obstruction 7.7% (requiring corticosteroid injection of anterior ethmoidal artery flap), and 0% infection/rehospitalization. Conclusion Anterior ethmoidal artery flap with an inlay collagen matrix is a reliable technique to repair nasal septal perforation. This technique, with robust vascularity and wide angle of rotation, enables the closure of perforations both large (<50% total septum) and with anterior locations.

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

2020 ◽  
pp. 000348942097059
Author(s):  
Benjamin G. Hunter
Keyword(s):  
Nasal Obstruction ◽  
Surgical Repair ◽  
Case Series ◽  
Collagen Matrix ◽  
Septal Perforation ◽  
Surgical Success ◽  
Interposition Graft ◽  
Patient Reported ◽  
Septal Perforations ◽  
Porcine Collagen

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.

Asymptomatic Nasal Septal Perforations in Systemic Lupus Erythematosus

1980 ◽  
Vol 89 (1) ◽  
pp. 78-80 ◽  
Author(s):  
David Reiter ◽  
Allen R. Myers
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Common Phenomenon ◽  
Septal Perforation ◽  
Systemic Lupus ◽  
Clinical Correlates ◽  
Nasal Septal Perforation ◽  
Diagnostic Criterion ◽  
Septal Perforations

Nasal septal perforation has been considered a diagnostic criterion for systemic lupus erythematosus since 1971. However, little has been published in the otorhinolaryngologic literature regarding this lesion. We report six patients having asymptomatic anteroinferior nasal septal perforations and symptomatic lupus. No obvious clinical correlates were found. We support the hypothesis that nasal septal perforation in systemic lupus erythematosus is a common phenomenon, and attribute its infrequent detection to the asymptomatic nature of the lesion in this setting.

scholarly journals Nasal Septal Perforation in Propylthiouracil-Induced Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Yusho Ishii ◽  
Tsuyoshi Shirai ◽  
Yousuke Hoshi ◽  
Yoko Fujita ◽  
Yuko Shirota ◽  
...  
Keyword(s):  
Nasal Septum ◽  
Rare Case ◽  
Inflammatory Cells ◽  
Graves Disease ◽  
Septal Perforation ◽  
Drug Induced ◽  
Nasal Septal Perforation ◽  
Anca Associated Vasculitis

Here, we present the case of a 29-year-old woman with nasal septal perforation and positive myeloperoxidase- (MPO-) anti-neutrophil cytoplasmic antibody (ANCA). She had been diagnosed with Graves’ disease and had been treated with propylthiouracil (PTU) for 14 months. A biopsy of the nasal septum revealed an infiltration of inflammatory cells, with no evidence of malignancy or granulomatous change. Because of the use of PTU, destructive nasal lesion, and positive MPO-ANCA, she was diagnosed with drug-induced ANCA-associated vasculitis (AAV) and was treated with prednisolone and methotrexate after the cessation of PTU. Although PTU is known to be the medicine that induces drug-induced AAV, the manifestation of nasal septal perforation in drug-induced AAV is poorly identified. This is the rare case of drug-induced AAV which manifested only nasal septal perforation.

Repair of Nasal Septal Perforation

1997 ◽  
Vol 11 (1) ◽  
pp. 35-40 ◽  
Author(s):  
Mohammed Yousef-Mian
Keyword(s):  
Success Rate ◽  
Double Layer ◽  
The Other ◽  
Septal Perforation ◽  
Current Analysis ◽  
Operative Techniques ◽  
Nasal Septal Perforation ◽  
Novel Method ◽  
Incomplete Closure ◽  
Septal Perforations

The management of nasal septal perforation remains unsatisfactory. Various operative techniques have been described, with modest success. A novel method for repair of septal perforations up to 2.6 cm in diameter was investigated. A double layer closure of nasal septal perforation was designed, one with the cartilage and the other by a flap based on the anterior septal branches of the sphenopalatine artery. Fourteen patients have been operated upon. The current analysis reveals a success rate of 13 patients (93%) who had complete closure and one patient (7%) with incomplete closure. The operative techniques and results are reported here.

Closure of Nasal Septal Perforations with a Polydioxanone Plate and Temporoparietal Fascia in a Closed Approach

2017 ◽  
Vol 31 (3) ◽  
pp. 190-195 ◽  
Author(s):  
Lorenz Epprecht ◽  
Christoph Schlegel ◽  
David Holzmann ◽  
Michael Soyka ◽  
Thomas Kaufmann
Keyword(s):  
Case Series ◽  
Invasive Technique ◽  
Flexible Plate ◽  
Open Approach ◽  
Septal Perforation ◽  
Temporoparietal Fascia ◽  
Closed Approach ◽  
First Time ◽  
Septal Perforations

Background Septal perforation closure is still often invasive and complex, with relatively low closure rates. Objectives We aimed to provide the first results of a case series of 20 patients with nasal septal perforations who underwent septal perforation repair by both an open and a minimally invasive technique by using a graft that consisted of temporoparietal fascia and a polydioxanone (PDS) plate without mucosal flaps. Between 2014 and 2016, we tested, for the first time, the feasibility of the insertion of this graft via a hemitransfixion incision at our institution. The rationale for the closed approach was to avoid any visible nasal scars. We reported our results of both approaches. Methods The septal perforations were closed by insertion of a graft, which consisted of a 0.25-mm PDS flexible plate enveloped by temporoparietal fascia, into the perforation. The insertion of the graft was performed either via a columellar incision (open approach) or via a cosmetically advantageous hemitransfixion incision (closed approach) in an underlay technique. No attempts were made to close the perforation by mucosal flap rotation and/or advancement. Protective silastic sheeting to both sides of the perforation provided fixation to the graft while natural mucosal healing occurred over the perforation in the course of 3 to 8 weeks. Results Eighteen of 20 perforations were closed by mucosa at the last follow-up. The mean follow-up was 8.7 months. Thirteen patients had surgery via the closed approach. Conclusion We showed, for the first time, that the insertion of a graft that consisted of a PDS flexible plate enveloped in temporoparietal fascia via a hemitransfixion incision was feasible and resulted in complete mucosal closure of nasal septal perforations in most patients. By performing the hemitransfixion incision, we avoided any visible nasal scars.

scholarly journals Nasal septum perforation – new treatment methods

New Medicine ◽  
2018 ◽  
Vol 22 (3) ◽  
Author(s):  
Michał Michalik ◽  
Adrianna Podbielska-Kubera ◽  
Agnieszka Dmowska-Koroblewska
Keyword(s):  
Nasal Septum ◽  
Trauma Surgery ◽  
Underlying Disease ◽  
Surgical Approaches ◽  
Surgical Closure ◽  
Temporal Fascia ◽  
Nasal Septal Perforation ◽  
Detailed Medical History ◽  
Septum Perforation ◽  
Nasal Septum Perforation

Perforation is a defect of nasal septum manifested by the disruption of mucosa in the cartillaginous or bone part of nasal septum or in both of the parts at the same time.As a result, disruption of air transport through the nose and impaired nasal physiology occur. Crusting, epistaxis, and wheezing arise. Perforations are classified according to their size, type, and localization. There are many causes for nasal septum perforation: trauma, surgery, tumors, coexistence of inflammatory, infectious, degenerative, and autoimmune diseases, and cocaine abuse. The assessment of a patient with nasal septum perforation includes detailed medical history, physical examination, diagnostic and laboratory tests. Treating the underlying disease is of primary importance. The second step involves closing the perforation. Perforations can be treated conservatively (pharmacologically) or surgically. The choice of approach depends on the etiology, size, and location of the perforation. Surgical approach is the most effective. Surgical closure of nasal septal perforation is a difficult procedure associated with many complications. All surgical approaches are based on two main principles: creating mucosal, mucoperichondrial, and/or mucoperiosteal flaps or transplant. Prosthetic treatment is another solution. Literature data shows that highest success rate is achieved after surgical procedures with the use of mucosal flaps and temporal fascia transplants, as well as acellular human dermal allografts.

scholarly journals Huge hard palate and nasal septum perforation as a presentation of syphilis: A case report

2012 ◽  
Vol 11 (3) ◽  
pp. 234-237
Author(s):  
B Shahrjerdi ◽  
I Mohamad
Keyword(s):  
Case Report ◽  
Nasal Septum ◽  
Hard Palate ◽  
Medical Science ◽  
Underlying Disease ◽  
Septal Perforation ◽  
Diagnostic Challenge ◽  
Septum Perforation ◽  
Nasal Septum Perforation ◽  
Septal Perforations

A patient presented with septal and palatal perforations imposes a diagnostic challenge because various potential causes need to be established. Therefore, elucidating the cause of the septal perforation requires obtaining a thorough history. In addition, it is very important to perform necessary investigations for the patients to determine and fix the underlying disease which cause these complaints. We report a case of patient presented with palatal and septal perforations which later was confirmed to have syphilis. DOI: http://dx.doi.org/10.3329/bjms.v11i3.11737 Bangladesh Journal of Medical Science Vol. 11 No. 03 July’12

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