Auricular Perichondrium Graft for Septal Perforation Repair

2021 ◽  
pp. 000348942110157
Author(s):  
Stephen F. Bansberg ◽  
Cullen M. Taylor ◽  
Gregory S. Neel
Keyword(s):  
Nasal Obstruction ◽  
Graft Material ◽  
Septal Perforation ◽  
Nasal Valve ◽  
Auricular Cartilage ◽  
Interposition Graft ◽  
Presenting Symptoms ◽  
Septal Surgery ◽  
Record Review

Objectives: Procedures which utilize bilateral mucosal flaps with an interposition graft are frequently used when attempting closure of a septal perforation. Concurrent surgical management of the nasal valve or an aesthetic deformity may be indicated. The objective of this study is to report our experience using auricular perichondrium for the interposition graft when auricular cartilage is harvested for structural or aesthetic graft material. Methods: A retrospective medical record review was performed for septal perforation repairs performed at Mayo Clinic in Arizona from January 2010 through January 2020. Patients identified for this study underwent a procedure utilizing bilateral nasal mucosal flaps with an auricular perichondrium interposition graft. Results: Forty-four patients (31 females) with a mean age of 53.3 years met study criteria. The most common presenting symptoms were nasal obstruction, crusting, and epistaxis. Prior septal surgery was the most common perforation etiology (45.5%). Mean perforation length was 11.8 (range, 3-26) mm and height, 9.1 (range, 2-16) mm. Auricular cartilage was harvested for nasal valve surgery in 43 patients. Complete perforation closure was noted in 95.3% (41/43) of patients with a minimum post-operative follow-up of 3 (mean, 20.4) months. Four patients underwent revision surgery for persistent postoperative nasal obstruction. Conclusion: The ear can provide both cartilage and perichondrium for use in septal perforation surgery. Our study demonstrates the successful use of auricular perichondrium as the interposition graft for a perforation closure procedure utilizing bilateral nasal mucosal flaps.

Outcomes of Septal Perforation Repair With Concurrent Endoscopic Sinus Surgery

2021 ◽  
pp. 019459982098291
Author(s):  
Yassmeen Abdel-Aty ◽  
Rachel B. Cain ◽  
Cullen Taylor ◽  
Michael J. Marino ◽  
Devyani Lal ◽  
...  
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Tertiary Care ◽  
Surgical Techniques ◽  
Sinus Surgery ◽  
Surgical Patient ◽  
Graft Material ◽  
Septal Perforation ◽  
Mucosal Flap ◽  
Interposition Graft

Objective This study reviews a cohort of patients in whom septal perforation repair was performed concurrently with endoscopic sinus surgery. We present an endonasal perforation repair technique using bilateral mucosal flaps with an autogenous interposition graft. Intraoperative and postoperative management of the combined surgical patient is discussed and perforation closure outcomes are reported. Study Design Case series. Setting Tertiary care center. Methods In this institutional review board–approved retrospective chart review, adult patients who underwent concurrent bilateral mucosal flap septal perforation repair and endoscopic sinus surgery from March 1992 to March 2020 were identified. Data on demographics, clinical presentations, perforation size, surgical techniques, and outcomes were extracted and analyzed for patients with a minimum of 3 months of follow-up. Results Fifty-six patients met study inclusion criteria. Nasal obstruction/congestion was the most frequent symptom reported (80.4%), followed by crusting and epistaxis. Mean perforation size measured at the time of surgery was 14.7 (range, 3-41) mm in length by 9.3 (range, 2-23) mm in height. Temporalis fascia was the most frequent (57.9%) interposition graft material used. Complete perforation closure at the time of the last follow-up was noted in 51 (91.1%) patients. Only 1 failure was noted in the last 48 attempted repairs. Conclusion Patients with a perforated septum may have coexistent chronic sinusitis. The feasibility of attempting concurrent sinus surgery and perforation repair has been questioned. Our review demonstrates a high perforation closure rate when a bilateral mucosal flap procedure is performed after sinus surgery is performed at the same setting.

scholarly journals Bioabsorbable Implant for Treatment of Nasal Valve Collapse with or without Concomitant Procedures

2021 ◽  
Author(s):  
Douglas M. Sidle ◽  
Pablo Stolovitzky ◽  
Ellen M. O'Malley ◽  
Randall A. Ow ◽  
Nathan E. Nachlas ◽  
...  
Keyword(s):  
Adverse Events ◽  
Nasal Obstruction ◽  
Large Population ◽  
Inferior Turbinate ◽  
Nasal Valve ◽  
Serious Adverse Events ◽  
Vas Scores ◽  
Nasal Implant ◽  
Nasal Valve Collapse

AbstractThe aim of the study is to report outcomes after treatment of nasal valve collapse with a bioabsorbable nasal implant. It involves two prospective, multicenter, post-market studies evaluating long-term effectiveness of the LATERA implant for severe to extreme nasal obstruction. Participants underwent implant alone or with concomitant inferior turbinate reduction (ITR) and/or septoplasty. Outcome measures included the change from baseline Nasal Obstruction Symptom Evaluation (NOSE) scores, NOSE responder rates, visual analog scale (VAS) scores, and adverse events. A total cohort of 277 participants (109 implants only, 67 implants + ITR, 101 implants + septoplasty + ITR) enrolled at 19 U.S. centers was available for analysis with 177 participants (69 implants only, 39 implants + ITR, 69 implants + septoplasty + ITR) available at 2 years. The mean changes from baseline in NOSE scores and VAS scores were statistically significant (p < 0.001) at all follow-up periods. The baseline NOSE score of 77.8 ± 13.6 was improved to 24.2 ± 23.6 at 24 months. Greater than 90% of participants were NOSE responders across all follow-up periods, 6.1% withdrew for lack of treatment effect. The baseline VAS score of 66.7 ± 18.8 was improved to 21.1 ± 23.9 at 24 months. There were no serious adverse events related to the device or implant procedure. Implant retrieval rate was 4.0% (22/543 implants). Nonserious adverse events were mild to moderate in severity, typically occurred within 6 months of implant, and resolved or were stable. Significant reductions in NOSE and VAS scores and high responder rates from our large population of patients with nasal obstruction who had nasal valve implants confirm sustained effectiveness at 24 months after treatment. The studies are registered on www.clinicaltrials.gov (NCT02952313 and NCT02964312).

Auricular Cartilage

2019 ◽  
pp. 91-94
Author(s):  
Ali Sajjadian
Keyword(s):  
Postoperative Pain ◽  
Donor Site ◽  
Graft Material ◽  
Cartilage Graft ◽  
Septal Perforation ◽  
Auricular Cartilage ◽  
Structural Support ◽  
First Choice ◽  
Graft Donor ◽  
Ear Cartilage

The ear is generally not a first choice as a cartilage graft donor site for several reasons, none of which is valid. When the graft is harvested anteriorly, the scar is well-concealed as long as the incision is placed within the rim of the conchal bowl. And, although no site can provide as much cartilage as the rib, the auricle can provide a surprisingly large amount of graft material. There is also characteristically minimal morbidity with the harvest of auricular cartilage. This distinguishes it from rib cartilage harvest, which may be accompanied by significant postoperative pain and occasionally pneumothorax. In addition, septal harvest may cause bleeding, saddling of the nose symptomatic of septal perforation, and other airflow disturbances. The most important and major problem with ear cartilage is the flaccidity inherent in its structure. This makes it a poor choice when significant structural support is mandatory.

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.

The results of septal button insertion in the management of nasal septal perforation

1999 ◽  
Vol 113 (9) ◽  
pp. 823-824 ◽  
Author(s):  
Üstün Osma ◽  
Sebahattin Cüreoǧlu ◽  
Nursel Akbulut ◽  
Faruk Meriç ◽  
Ismail Topçu
Keyword(s):  
Nasal Obstruction ◽  
Septal Perforation ◽  
Nasal Septal Perforation

AbstractNasal septal perforation may present with various symptoms. Perforations may be surgically closed or managed by obturation, inserting a prosthesis. We used a silicon septal button in the management of nasal septal perforation. In the follow-up period, although the insertion of the nasal septal button alleviated epistaxis, whistling during inspiration, and nasal obstruction, it could not control the production of crusting around the margin of the button.

Management of the Internal Nasal Valve

2013 ◽  
Vol 5 (1) ◽  
pp. 21-23
Author(s):  
Ng Li Shia ◽  
Lo Stephen
Keyword(s):  
Nasal Obstruction ◽  
Previous History ◽  
Graft Material ◽  
Nasal Valve ◽  
Management Planning ◽  
History Of ◽  
Nasal Trauma ◽  
Valve Pathology ◽  
Nasal Valve Collapse ◽  
Underlying Pathology

ABSTRACT Nasal obstruction is one of the most common nose complaints. Internal nasal valve dysfunction is an important cause of nasal obstruction, particularly in patients who have a previous history of nasal trauma or reduction rhinoplasty. Correct assessment is crucial for accurate diagnosis and appropriate management planning. Various surgical and nonsurgical modalities for addressing the problem of internal nasal valve collapse are being reviewed in this paper. Each technique have their own advantages and disadvantage, and the choice depends on the underlying pathology, patient preference, availability of graft material. The rhinoplasty surgeon should have a thorough understanding of the available options as part of his/her armamentarium in dealing with internal nasal valve pathology.

Contemporary Trends in the Surgical Management of Nasal Septal Perforations: A Community Survey

2018 ◽  
Vol 35 (01) ◽  
pp. 078-084 ◽  
Author(s):  
Russell Kridel ◽  
Sean Delaney
Keyword(s):  
Surgical Management ◽  
Graft Material ◽  
Septal Perforation ◽  
Success Rates ◽  
Surgical Closure ◽  
Interposition Graft ◽  
Facial Plastic ◽  
Advancement Flaps ◽  
External Rhinoplasty ◽  
Septal Perforations

AbstractThere currently exists an overabundance of publications advocating different septal perforation repair methods. The objective of this article was to examine the preponderance of techniques and trends in the surgical management of septal perforations in the practices of otolaryngologists, rhinologists, and facial plastic surgeons. The study was designed as a multicenter cross-sectional survey. The participants were members of the American Academy of Facial Plastic and Reconstructive Surgery and the American Rhinologic Society. Septal perforation closure rates and perforation repair approach, technique, and interposition graft material preferences were the main outcomes. A total of 320 respondents completed the survey, of whom 75% performed perforation repairs. The success rates in closing perforations < 1 cm, 1–2 cm, and > 2 cm were 84%, 64%, and 31%, respectively. The respondents had a similar preference for the endoscopic (52%) and external rhinoplasty (49%) approaches, followed by the endonasal approach (43%). Bilateral intranasal mucosal advancement flaps (79%) and unilateral intranasal mucosal rotational or advancement flaps (60%) were the favored repair techniques. Most respondents (84%) incorporated an interposition graft and intranasal splints (89%) for the repair, and the most popular interposition graft material was acellular dermis (63%). The self-reported perforation closure success rates in this survey were lower than those published in the literature, a phenomenon possibly explained by the premise that surgeons with favorable outcomes are more apt to share their results. The preferred surgical approach was evenly distributed between the external rhinoplasty and endoscopic approaches and influenced by a surgeon's training, perforation size and location, and the need for concomitant rhinoplasty. This study is the first to characterize contemporary community trends in the surgical closure of septal perforations and demonstrates that while preference for perforation repair approach among the respondents varied, surgeons favored septal perforation repair using bilateral intranasal mucosal advancement flaps with an interposition graft.

Simultaneous Septal Perforation Repair with Septorhinoplasty: A 31-Year Experience

2018 ◽  
Vol 34 (03) ◽  
pp. 298-311 ◽  
Author(s):  
Sean Delaney ◽  
Russell Kridel
Keyword(s):  
Symptom Relief ◽  
Advancement Flap ◽  
Open Approach ◽  
Septal Perforation ◽  
Cosmetic Results ◽  
Presenting Symptoms ◽  
The Mean ◽  
Four Quadrant ◽  
Anterior Posterior

AbstractSeptal perforation repair and septorhinoplasty (SRP) each present unique surgical challenges. However, in many instances, these procedures may be performed together successfully. In this study, the authors aim to determine the safety and effectiveness of combining primary or revision SRP and septal perforation repair via an open approach. A retrospective review was carried out of all consecutive patients who had SRP and septal perforation repair via an open approach between 1986 and 2017 in the senior author's practice. Perforation closure in surgery and at the patient's last follow-up, resolution of presenting symptoms, cosmetic results, and complications were analyzed. Records for 141 patients who had simultaneous septal perforation repair and SRP via an open approach, with a mean follow-up of 3.24 years, were reviewed. The mean anterior–posterior perforation dimension was 1.41 ± 0.89 cm, and the mean vertical perforation dimension was 1.16 ± 0.59 cm. The most common etiologies for septal perforation were previous SRP (35.4%) and septoplasty (24.1%). An overall 93.6%, perforation closure, 91.1% symptom relief, and 91.2% patient satisfaction with cosmetic results were achieved. Septal perforations under 1.5 cm in height were closed in 96.7% of patients as opposed to 71.4% of patients with perforations 1.5 cm or taller. Minor revision rhinoplasties were performed in 7.0% of patients. Postoperative infections were rare and noted in only two (1.4%) patients. In the largest study of its kind to date, the authors have shown that in experienced hands septal perforation repair may be performed simultaneously with primary or revision SRP via an open approach without compromising the perforation repair outcome. The vertical dimension of a septal perforation and presence of mucosa above and below a perforation are important considerations for the difficulty of a perforation closure, as septal mucosa is recruited from these locations in our technique of four-quadrant intranasal bipedicled mucosal advancement flap closure.

Concomitant Rhinoplasty and Septal Perforation Repair

2020 ◽  
Vol 36 (01) ◽  
pp. 078-083 ◽  
Author(s):  
Russell W.H. Kridel ◽  
Sean W. Delaney
Keyword(s):  
Nasal Obstruction ◽  
Septal Perforation ◽  
Septal Surgery ◽  
Septal Perforations

AbstractThe rhinoplasty surgeon may encounter nasal septal perforations (NSPs) during the examination of the prospective rhinoplasty candidate, many of whom have had prior septal surgery. While small NSPs may be asymptomatic, larger NSPs may cause nasal obstruction, crusting, bleeding, or external nasal deformities. Septal perforation repair and rhinoplasty can be safely and effectively performed simultaneously for the appropriate surgical candidate. In this article, we review the important considerations when determining the surgical candidacy for concomitant rhinoplasty and septal perforation repair.

Management of the narrow nose

2009 ◽  
Vol 123 (9) ◽  
pp. 945-951 ◽  
Author(s):  
H Wallace ◽  
S Sood ◽  
A Rafferty
Keyword(s):  
Nasal Obstruction ◽  
Correct Diagnosis ◽  
Surgical Techniques ◽  
Complex Problem ◽  
Graft Material ◽  
Nasal Valve ◽  
Surgical Experience ◽  
Management Planning ◽  
Nasal Valve Collapse ◽  
Choice Of Technique

AbstractNasal obstruction is one of the most common complaints in the otolaryngology clinic. It can be a complex problem and may be multifactorial. Nasal valve dysfunction can be a cause of nasal obstruction, particularly in patients who have undergone previous reduction rhinoplasty. The exact site of the nasal valve is contentious and is frequently subdivided into the internal and external nasal valves. Accurate assessment is crucial for correct diagnosis and management planning. Various surgical and non-surgical techniques for addressing the problem of nasal valve collapse have been described in the literature. The choice of technique will depend on the causative pathology, availability of graft material, surgical experience and patient preference.

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